WO2020119112A1 - 保费定价模型的建立方法、装置、设备及存储介质 - Google Patents

保费定价模型的建立方法、装置、设备及存储介质 Download PDF

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WO2020119112A1
WO2020119112A1 PCT/CN2019/095631 CN2019095631W WO2020119112A1 WO 2020119112 A1 WO2020119112 A1 WO 2020119112A1 CN 2019095631 W CN2019095631 W CN 2019095631W WO 2020119112 A1 WO2020119112 A1 WO 2020119112A1
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compensation
target drug
target
rate
premium pricing
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PCT/CN2019/095631
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English (en)
French (fr)
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李云峰
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平安医疗健康管理股份有限公司
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    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06QINFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q30/00Commerce
    • G06Q30/02Marketing; Price estimation or determination; Fundraising
    • G06Q30/0283Price estimation or determination
    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06QINFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q40/00Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/08Insurance

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  • the present application relates to the field of data processing technology, and in particular, to a method, device, device, and computer-readable storage medium for establishing a premium pricing model.
  • the main purpose of the present application is to provide a method, device, equipment and computer-readable storage medium for establishing a premium pricing model, aiming to solve the technical problem of low accuracy of the existing premium pricing model.
  • the present application provides a method for establishing a premium pricing model.
  • the method for establishing a premium pricing model includes the following steps:
  • the step of calculating the historical claim rate of the target drug as the standard claim rate of the target drug according to the disease record parameter and the medication record parameter corresponding to the target drug includes:
  • the method further includes:
  • the theoretical compensation rate of the target drug is calculated as the standard compensation rate of the target drug, wherein the calculation of the theoretical compensation rate is based on the following formula:
  • the theoretical compensation rate Adjusted parameter for estimated loss rate * Theoretical incidence rate.
  • the method further includes:
  • target payout rate Historical compensation rate* (1+ preset additional risk parameters).
  • the step of obtaining the preset payment rule corresponding to the target drug and the annual per capita fee when receiving the model establishment request based on the target drug includes:
  • the preset compensation rules for the target drug in the target city are obtained, and the historical drug per capita annual cost of the target drug in the target city is obtained as the annual per capita cost.
  • the preset payment rule includes a payment limit and a payment ratio
  • the step of calculating the per capita payment parameter of the target drug according to the per capita annual fee and the preset payment rule includes:
  • the calculation of the per capita compensation parameters is based on the following formula: A is the per capita compensation parameter, i is the per capita annual fee, j is the compensation limit, and k is the compensation ratio.
  • the step of acquiring the premium pricing rule of the target drug and generating the premium pricing model of the target drug according to the preset premium pricing rule, the per capita compensation parameter and the standard compensation rate includes:
  • the premium pricing model of the target drug is generated according to the preset premium pricing rules, operating cost, tax rate, target profit, per capita compensation parameters, and standard compensation rate.
  • the present application also provides a device for establishing a premium pricing model.
  • the device for establishing a premium pricing model includes:
  • the parameter calculation module is used to obtain the preset compensation rules and the annual per capita cost corresponding to the target drug when receiving the model establishment request based on the target drug, and calculate the Per capita compensation parameters of target drugs;
  • the compensation rate calculation module is used to calculate the historical compensation rate of the target drug according to the disease record parameter and the medication record parameter corresponding to the target drug as the standard payment rate of the target drug;
  • the model generation module is used to obtain the premium pricing rules of the target drug, and generate the premium pricing model of the target drug according to the preset premium pricing rule, the per capita compensation parameter and the standard compensation rate.
  • the present application also provides a device for establishing a premium pricing model.
  • the device for establishing a premium pricing model includes a processor, a memory, and an executable program stored on the memory and executable by the processor Computer readable instructions, where the computer readable instructions, when executed by the processor, implement the steps of the method for establishing a premium pricing model as described above.
  • the present application also provides a computer-readable storage medium having computer-readable instructions stored on the computer-readable storage medium, wherein when the computer-readable instructions are executed by a processor, the implementation is as described above The steps of establishing a premium pricing model.
  • This application provides a method for establishing a premium pricing model, that is, when receiving a model-building request based on a target drug, the preset payment rules corresponding to the target drug and the per capita annual fee are obtained, and the Set up compensation rules to calculate the per capita compensation parameters of the target drugs;
  • FIG. 1 is a schematic diagram of a hardware structure of a device for establishing a premium pricing model involved in an embodiment of the present application
  • FIG. 2 is a schematic flowchart of a first embodiment of a method for establishing a premium pricing model for an application
  • FIG. 3 is a schematic flowchart of a second embodiment of a method for establishing a premium pricing model of the application
  • FIG. 4 is a schematic flowchart of a third embodiment of a method for establishing a premium pricing model of the application
  • FIG. 5 is a schematic diagram of functional modules of a first embodiment of a device for establishing a premium pricing model of the application.
  • the method for establishing a premium pricing model is mainly applied to a device for establishing a premium pricing model.
  • the device for establishing a premium pricing model may be a device with display and processing functions such as a PC, a portable computer, and a mobile terminal.
  • FIG. 1 is a schematic diagram of a hardware structure of a device for establishing a premium pricing model involved in an embodiment of the present application.
  • the device for establishing the premium pricing model may include a processor 1001 (for example, a CPU), a communication bus 1002, a user interface 1003, a network interface 1004, and a memory 1005.
  • the communication bus 1002 is used to realize the connection and communication between these components;
  • the user interface 1003 may include a display (Display), an input unit such as a keyboard (Keyboard);
  • the network interface 1004 may optionally include a standard wired interface, a wireless interface (Such as WI-FI interface);
  • the memory 1005 can be a high-speed RAM memory or a non-volatile memory (non-volatile memory), such as a disk memory, and the memory 1005 can optionally be a storage device independent of the foregoing processor 1001 .
  • FIG. 1 does not constitute a limitation on the equipment for establishing a premium pricing model, and may include more or less components than the illustration, or a combination of certain components, or different Parts layout.
  • the memory 1005 in FIG. 1 as a computer-readable storage medium may include an operating system, a network communication module, and computer-readable instructions.
  • the network communication module is mainly used to connect to a server and perform data communication with the server; and the processor 1001 can call computer-readable instructions stored in the memory 1005 and execute the method for establishing a premium pricing model provided by the embodiments of the present application .
  • the embodiment of the present application provides a method for establishing a premium pricing model.
  • FIG. 2 is a schematic flowchart of a first embodiment of a method for establishing a premium pricing model of this application.
  • the method for establishing the premium pricing model includes the following steps:
  • Step S10 When receiving a model establishment request based on the target drug, obtain the preset compensation rules and the annual per capita fee corresponding to the target drug, and calculate the target drug's Payout parameters per capita;
  • the indicators used are usually fixed for a long time, such as gender and age.
  • the fixed premium pricing model has the problem of low pricing accuracy.
  • a method for establishing a premium pricing model is provided.
  • axitinib tablets are used as an example.
  • the server obtains the preset payment rules corresponding to the target drugs and the average annual cost per person from the database.
  • the per capita annual cost may be the per capita annual cost of the target drug recorded in the reference city Chinese medicine hospital system (or medical system). If the per capita annual fee does not exist in the TCM system (or medical system), the historical drug annual fee of the target drug can be obtained, and then the historical drug annual fee is divided by the number of users to obtain the per capita annual fee.
  • the preset payment rule may be determined according to the insurance plan corresponding to the target drug. Specifically, when the server obtains the per capita annual cost of axitinib tablets, it will obtain a preset axitinib insurance plan, which includes a payment limit (including upper and lower limits) and a payment ratio, such as
  • the per capita compensation parameters when the insurance plan for axitinib tablets is for customers who are insured for the first time (first year), the per capita compensation parameters also need to consider other adjustment factors.
  • the adjustment factor is based on a preset first year
  • Step S20 according to the disease record parameter and the medication record parameter corresponding to the target drug, calculate the historical compensation rate of the target drug as the standard compensation rate of the target drug;
  • the server when it obtains the per capita compensation parameters of axitinib tablets, it can calculate the risk premium of the insurance plan according to the per capita compensation parameters of axitinib tablets; for the risk premiums, it refers to just used to pay the compensation, so To calculate the risk premium, you also need to first obtain the probability of the occurrence of the compensation event, that is, the historical payment rate of axitinib tablets.
  • the historical compensation rate is the probability of guaranteeing patients to choose axitinib tablets among many drugs.
  • the historical compensation rate may be calculated based on the disease records and medication records of the reference city.
  • the disease record parameters include the prevalence, diagnosis, and treatment rates of adult advanced renal cell carcinoma RCC
  • the drug use rate of the target drug may also be used Just predict.
  • the risk premium when the insurance plan of axitinib tablets is for customers who are insured for the first time (first year), the risk premium also needs to consider the competitive factors on the market (that is, whether there are other therapeutic drugs on the market)
  • Step S30 Obtain the premium pricing rule of the target drug, and generate the premium pricing model of the target drug according to the preset premium pricing rule, the per capita compensation parameter and the standard compensation rate.
  • step S30 specifically includes:
  • the premium pricing model of the target drug is generated according to the preset premium pricing rules, operating cost, tax rate, target profit, per capita compensation parameters, and standard compensation rate.
  • the operating expenses of the insurance plan of axitinib tablets can be understood as operating costs, including system fees and labor costs, where system fees include interface fees and dedicated line fees, and labor costs are the number of offline outlets and the average salary The product of.
  • the tax rate and profit target it can be set according to the actual situation.
  • the server obtains the risk premium of the insurance plan, it can obtain the related operating expenses, tax rate and profit target information according to the business system, and then according to the calculation formula of the premium pricing of the axitinib insurance plan, that is
  • Premium pricing (risk premium + operating expenses)/(1-tax-fee ratio-margin target), the corresponding premium pricing model can be generated.
  • the server when the server calculates the premium pricing of the axitinib insurance plan, it can feed back the premium pricing to the corresponding business terminal (or insured terminal), so that the business personnel can charge according to the premium pricing (Or make the policyholder pay the fee).
  • the insured After applying for insurance, the insured can send a claim request to the server through the corresponding terminal if there is a claim event (purchasing or using axitinib tablets).
  • the server receives the claim request, it will obtain the corresponding claim review materials according to the applicable disease type of axitinib tablets, such as the pathological diagnosis or arterial thromboembolism diagnosis necessary for the advanced renal cell carcinoma review; then the server may The materials determine whether the insured person meets the claims conditions. If it meets the requirements, the actual cost of the axitinib tablets purchased by the insured person can be obtained, and the claim expenses can be calculated in combination with the compensation ratio in the insurance plan.
  • This embodiment provides a method for establishing a premium pricing model, that is, when receiving a model-building request based on a target drug, the preset compensation rules corresponding to the target drug and the average annual cost per capita are obtained, and according to the average annual cost and Preset compensation rules to calculate the per capita compensation parameters of the target drug;
  • FIG. 3 is a schematic flowchart of a second embodiment of a method for establishing a premium pricing model of this application.
  • the step S20 specifically includes:
  • Step S21 judging whether there is a disease record parameter and a medication record parameter of the target drug in the database
  • the disease recording parameters include the prevalence, diagnosis rate, and treatment rate of adult advanced renal cell carcinoma RCC
  • the drug recording parameters include the acitinib tablet use rate.
  • Step S22 if the disease record parameter and medication record parameter do not exist in the database, the theoretical incidence rate of the target drug corresponding to the treatment disease is obtained;
  • the estimated compensation rate adjustment parameters are obtained, and the theoretical morbidity and the estimated compensation rate adjustment parameters are multiplied to obtain the theoretical compensation rate, and the calculated theoretical compensation rate is used as the standard compensation rate.
  • the adjustment parameters of the estimated compensation rate can be set correspondingly according to specific drugs corresponding to specific cities.
  • the method further includes:
  • target payout rate Historical compensation rate* (1+ preset additional risk parameters).
  • FIG. 4 is a schematic flowchart of a third embodiment of a method for establishing a premium pricing model of this application.
  • the step S10 includes:
  • Step S11 When receiving a model establishment request based on the target drug, obtain the target city identifier in the premium pricing request;
  • the server when the server receives the axitinib-based premium calculation request, it first needs to obtain the per capita annual cost of axitinib tablets; it is worth noting that due to the climate, consumption level, and population characteristics of different cities Each case is different, so this case is for each city to obtain the corresponding per capita annual cost of axitinib tablets.
  • the target city identification may be obtained directly, and the relevant data of the target drug in the target city may be obtained according to the target city identification.
  • the target drug in the target city can also be obtained from historical data of a reference city with similar characteristics to the target city (where the “similarity” of this characteristic can be obtained through the above-mentioned climate , Consumption level, population characteristics and other dimensions).
  • step S12 according to the target city identifier, a preset payment rule for the target drug in the target city is obtained, and the historical drug per capita annual cost of the target drug in the target city is obtained as the annual per capita cost.
  • the preset compensation rule includes a compensation limit and a compensation ratio
  • the step of calculating the per capita compensation parameter of the target drug according to the per capita annual fee and the preset compensation rule includes:
  • the calculation of the per capita compensation parameters is based on the following formula: A is the per capita compensation parameter, i is the per capita annual fee, j is the compensation limit, and k is the compensation ratio.
  • the server will obtain the historical drug cost (historical data) of the target drug in the target city.
  • the historical drug cost may be obtained in the reference city TCM system (or medical system), including the reference city
  • the server may obtain the estimated annual per capita cost in a predictive manner.
  • the server will first calculate the theoretical annual per capita cost based on the method of use of axitinib tablets, the unit price of the preset instructions, and the preferential charity plan; for example, the price of axitinib tablets is 2250 yuan per box, and 3 boxes are used per month ,
  • the theoretical per capita annual cost can be multiplied by a predetermined estimated cost adjustment factor, and the obtained product can be used as the estimated annual per capita cost of axitinib tablets, where the estimated The cost adjustment factor can be set according to the actual situation.
  • both the historical annual per capita cost obtained by referring to the historical data of the city or the estimated annual per capita cost predicted by the instruction manual belong to the annual per capita cost of experience, in order to make the calculation result consistent with In actual situations, it is necessary to introduce a preset additional risk factor and time trend factor to characterize the risk situation that may be brought by the next insurance cycle, and according to the historical annual per capita/estimated annual per capita cost, additional risk factor, Time trend factor to calculate the annual per capita cost of axitinib tablets, ie
  • Per capita annual cost of axitinib tablets historical per capita annual cost/estimated per capita annual cost * (1 + cost additional risk factor) * (1 + time trend factor).
  • a preset payment rule for the target drug is further obtained, wherein the preset payment rule may be determined according to an insurance plan corresponding to the target drug.
  • the server when the server obtains the per capita annual cost of axitinib tablets, the server will obtain a preset axitinib insurance plan, which includes a payment limit (including an upper limit and a lower limit) and a payment ratio.
  • the calculation of parameters is based on the following formula: A is the per capita compensation parameter, i is the per capita annual fee, j is the compensation limit, and k is the compensation ratio.
  • the insurance plan includes multiple stages, for example,
  • X is the per capita compensation parameter.
  • the embodiments of the present application also provide a device for establishing a premium pricing model.
  • FIG. 5 is a schematic diagram of functional modules of a first embodiment of an apparatus for establishing a premium pricing model of the present application.
  • the device for establishing the premium pricing model includes:
  • the parameter calculation module 10 is used to obtain the preset compensation rules and the annual per capita cost corresponding to the target drug when receiving the model establishment request based on the target drug, and calculate the Describe the per capita compensation parameters of the target drug;
  • the compensation rate calculation module 20 is used to calculate the historical compensation rate of the target drug according to the disease record parameter and the medication record parameter corresponding to the target drug as the standard payment rate of the target drug;
  • the model generation module 30 is used to obtain the premium pricing rule of the target drug, and generate the premium pricing model of the target drug according to the preset premium pricing rule, the per capita compensation parameter and the standard compensation rate.
  • model generation module 30 includes:
  • a parameter obtaining unit used to obtain the premium pricing rules of the target drug, and obtain the operating cost, tax rate and target profit corresponding to the target drug;
  • a model generating unit is used to generate a premium pricing model of the target drug according to the preset premium pricing rules, operating cost, tax rate, target profit, per capita compensation parameters and standard compensation rate.
  • the compensation rate calculation module 20 includes:
  • a parameter judging unit used to judge whether there is a disease record parameter and a medication record parameter of the target drug in the database
  • the morbidity obtaining unit is configured to obtain the theoretical morbidity corresponding to the treatment of the target drug if the disease recording parameter and medication recording parameter do not exist in the database;
  • the second calculation unit is configured to calculate the historical compensation rate of the target drug according to the disease record parameter and the medication record parameter if the disease record parameter and the medication record parameter exist in the database as the target drug
  • the device for establishing a premium pricing model further includes:
  • parameter calculation module 10 includes:
  • An identification acquisition unit configured to acquire the target city identification in the premium pricing request when receiving a model establishment request based on the target drug
  • the third calculation unit is used to obtain the preset payment rule of the target drug in the target city according to the target city identifier, and obtain the historical drug per capita annual cost of the target drug in the target city as the annual per capita cost .
  • parameter calculation module 10 is also used to:
  • the calculation of the per capita compensation parameters is based on the following formula: A is the per capita compensation parameter, i is the per capita annual fee, j is the compensation limit, and k is the compensation ratio.
  • each module in the device for establishing a premium pricing model corresponds to each step in the embodiment of the method for establishing a premium pricing model, and its functions and implementation processes will not be repeated here one by one.
  • embodiments of the present application also provide a computer-readable storage medium, and the computer-readable storage medium may be a non-volatile readable storage medium.
  • the computer-readable storage medium of the present application stores computer-readable instructions, where the computer-readable instructions are executed by a processor to implement the steps of the method for establishing a premium pricing model as described above.
  • the methods in the above embodiments can be implemented by means of software plus a necessary general hardware platform, and of course, can also be implemented by hardware, but in many cases the former is better Implementation.
  • the technical solution of the present application can be embodied in the form of a software product in essence or part that contributes to the existing technology, and the computer software product is stored in a storage medium (such as ROM/RAM as described above) , Magnetic disk, optical disk), including several instructions to make a terminal device (which can be a mobile phone, computer, server, air conditioner, or network equipment, etc.) to perform the method described in each embodiment of the present application.

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Abstract

本申请提供一种保费定价模型的建立方法、装置、设备及存储介质,即在接收到基于目标药物的模型建立请求时,获取所述目标药物对应的预设赔付规则以及人均年费用,并根据所述人均年费用和预设赔付规则,计算所述目标药物的人均赔付参数;根据所述目标药物对应的疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率;获取所述目标药物的保费定价规则,并根据所述预设保费定价规则、人均赔付参数以及标准赔付率,生成所述目标药物的保费定价模型。本申请基于大数据分析针对不同药物的实际参数生成保费定价模型,提高了定价模型的定价准确度,解决了现有保费定价模型准确度低下的技术问题。

Description

保费定价模型的建立方法、装置、设备及存储介质
本申请要求于2018年12月13日提交中国专利局、申请号为201811524259.0、发明名称为“保费定价模型的建立方法、装置、设备及存储介质”的中国专利申请的优先权,其全部内容通过引用结合在申请中。
技术领域
本申请涉及数据处理技术领域,尤其涉及一种保费定价模型的建立方法、装置、设备及计算机可读存储介质。
背景技术
随着市场上特殊药品(特药)的增多,特药的使用量也越来越大,而特药一般价格昂贵,如阿昔替尼片(英立达)是一种用于既往接受过一种酪氨酸激酶抑制剂或细胞因子治疗失败的进展期肾细胞癌(RCC)的成人患者。为了减轻患者负担,急需将特药纳入医疗保险范畴。在保险业务中,通常是采用保险定价模型计算出保费。目前在建立保险定价模型时,采用的指标通常是长久固定不变的,如性别、年龄等。因此,如何解决现有保费定价模型准确度低下的问题,成为了目前亟待解决的技术问题。
发明内容
本申请的主要目的在于提供一种保费定价模型的建立方法、装置、设备及计算机可读存储介质,旨在解决现有保费定价模型准确度低下的技术问题。
为实现上述目的,本申请提供一种保费定价模型的建立方法,所述保费定价模型的建立方法包括以下步骤:
在接收到基于目标药物的模型建立请求时,获取所述目标药物对应的预设赔付规则以及人均年费用,并根据所述人均年费用和预设赔付规则,计算所述目标药物的人均赔付参数;
根据所述目标药物对应的疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率;
获取所述目标药物的保费定价规则,并根据所述预设保费定价规 则、人均赔付参数以及标准赔付率,生成所述目标药物的保费定价模型。
可选地,所述根据所述目标药物对应的疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率的步骤包括:
判断所述数据库中是否存在所述目标药物的疾病记录参数和用药记录参数;
若所述数据库中存在所述疾病记录参数和用药记录参数,则根据所述疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率,其中,所述历史赔付率的计算依据以下公式:历史赔付率=疾病记录参数*用药记录参数。
可选地,所述判断所述数据库中是否存在所述目标药物的疾病记录参数和用药记录参数的步骤之后,还包括:
若所述数据库中不存在所述疾病记录参数和用药记录参数,则获取所述目标药物对应治疗疾病的理论发病率;
根据预估赔付率调整参数和所述理论发病率,计算所述目标药物的理论赔付率,作为所述目标药物的标准赔付率,其中,所述理论赔付率的计算依据以下公式:理论赔付率=预估赔付率调整参数*理论发病率。
可选地,所述若所述数据库中存在所述疾病记录参数和用药记录参数,则根据所述疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率的步骤之后,还包括:
根据所述目标药物对应的预设附加风险参数,计算所述目标药物的目标赔付率,作为所述目标药物的标准赔付率,其中,所述目标赔付率的计算依据以下公式:目标赔付率=历史赔付率*(1+预设附加风险参数)。
可选地,所述在接收到基于目标药物的模型建立请求时,获取所述目标药物对应的预设赔付规则以及人均年费用的步骤包括:
在接收到基于目标药物的模型建立请求时,获取所述保费定价请求中的目标城市标识;
根据所述目标城市标识,获取所述目标药物在目标城市的预设赔付规则,并获取所述目标药物在所述目标城市的历史药物人均年费用,作为人均年费用。
可选地,所述预设赔付规则包括赔付限额和赔付比例,所述根据所述人均年费用和预设赔付规则,计算所述目标药物的人均赔付参数的步骤包括:
获取所述目标药物在所述目标城市的赔付限额和赔付比例,并根据所述人均年费用、赔付限额和赔付比例,计算所述目标药物的人均赔付参数,
其中,所述人均赔付参数的计算依据以下公式:
Figure PCTCN2019095631-appb-000001
A为人均赔付参数,i为人均年费用,j为赔付限额,k为赔付比例。
可选地,所述获取所述目标药物的保费定价规则,并根据所述预设保费定价规则、人均赔付参数以及标准赔付率,生成所述目标药物的保费定价模型的步骤包括:
获取所述目标药物的保费定价规则,并获取所述目标药物对应的运营成本费用、税费比例以及目标利润;
根据所述预设保费定价规则、运营成本费用、税费比例、目标利润、人均赔付参数以及标准赔付率,生成所述目标药物的保费定价模型。
此外,为实现上述目的,本申请还提供一种保费定价模型的建立装置,所述保费定价模型的建立装置包括:
参数计算模块,用于在接收到基于目标药物的模型建立请求时,获取所述目标药物对应的预设赔付规则以及人均年费用,并根据所述人均年费用和预设赔付规则,计算所述目标药物的人均赔付参数;
赔付率计算模块,用于根据所述目标药物对应的疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率;
模型生成模块,用于获取所述目标药物的保费定价规则,并根据所述预设保费定价规则、人均赔付参数以及标准赔付率,生成所述目 标药物的保费定价模型。
此外,为实现上述目的,本申请还提供一种保费定价模型的建立设备,所述保费定价模型的建立设备包括处理器、存储器、以及存储在所述存储器上并可被所述处理器执行的计算机可读指令,其中所述计算机可读指令被所述处理器执行时,实现如上述的保费定价模型的建立方法的步骤。
此外,为实现上述目的,本申请还提供一种计算机可读存储介质,所述计算机可读存储介质上存储有计算机可读指令,其中所述计算机可读指令被处理器执行时,实现如上述的保费定价模型的建立方法的步骤。
本申请提供一种保费定价模型的建立方法,即在接收到基于目标药物的模型建立请求时,获取所述目标药物对应的预设赔付规则以及人均年费用,并根据所述人均年费用和预设赔付规则,计算所述目标药物的人均赔付参数;
根据所述目标药物对应的疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率;获取所述目标药物的保费定价规则,并根据所述预设保费定价规则、人均赔付参数以及标准赔付率,生成所述目标药物的保费定价模型。通过上述方式,本申请针对不同药物设定不同的预设赔付规则,并根据所述目标药物对应的实际人均年费用计算出实际人均赔付参数,然后结合目标药物的标准赔付率和保费定价规则,生成保费定价模型,提高了定价模型的定价准确度,解决了现有保费定价模型准确度低下的技术问题。
附图说明
图1为本申请实施例方案中涉及的保费定价模型的建立设备的硬件结构示意图;
图2为本申请保费定价模型的建立方法第一实施例的流程示意图;
图3为本申请保费定价模型的建立方法第二实施例的流程示意图;
图4为本申请保费定价模型的建立方法第三实施例的流程示意图;
图5为本申请保费定价模型的建立装置第一实施例的功能模块示意图。
本申请目的的实现、功能特点及优点将结合实施例,参照附图做进一步说明。
具体实施方式
应当理解,此处所描述的具体实施例仅仅用以解释本申请,并不用于限定本申请。
本申请实施例涉及的保费定价模型的建立方法主要应用于保费定价模型的建立设备,该保费定价模型的建立设备可以是PC、便携计算机、移动终端等具有显示和处理功能的设备。
参照图1,图1为本申请实施例方案中涉及的保费定价模型的建立设备的硬件结构示意图。本申请实施例中,保费定价模型的建立设备可以包括处理器1001(例如CPU),通信总线1002,用户接口1003,网络接口1004,存储器1005。其中,通信总线1002用于实现这些组件之间的连接通信;用户接口1003可以包括显示屏(Display)、输入单元比如键盘(Keyboard);网络接口1004可选的可以包括标准的有线接口、无线接口(如WI-FI接口);存储器1005可以是高速RAM存储器,也可以是稳定的存储器(non-volatile memory),例如磁盘存储器,存储器1005可选的还可以是独立于前述处理器1001的存储装置。
本领域技术人员可以理解,图1中示出的硬件结构并不构成对保费定价模型的建立设备的限定,可以包括比图示更多或更少的部件,或者组合某些部件,或者不同的部件布置。
继续参照图1,图1中作为一种计算机可读存储介质的存储器1005可以包括操作***、网络通信模块以及计算机可读指令。
在图1中,网络通信模块主要用于连接服务器,与服务器进行数据通信;而处理器1001可以调用存储器1005中存储的计算机可读指令,并执行本申请实施例提供的保费定价模型的建立方法。
本申请实施例提供了一种保费定价模型的建立方法。
参照图2,图2为本申请保费定价模型的建立方法第一实施例的流程示意图。
本实施例中,所述保费定价模型的建立方法包括以下步骤:
步骤S10,在接收到基于目标药物的模型建立请求时,获取所述目标药物对应的预设赔付规则以及人均年费用,并根据所述人均年费用和预设赔付规则,计算所述目标药物的人均赔付参数;
目前,在建立保险定价模型时,采用的指标通常是长久固定不变的,如性别、年龄等。但是,固定的保费定价模型存在定价准确度低下的问题。
本实施例中,为了解决上述技术问题,提供一种保费定价模型的建立方法,本实施例中以阿昔替尼片进行举例。服务器在接收到基于阿昔替尼片的模型建立请求时,在数据库中获取所述目标药物对应的预设赔付规则以及人均年费用。其中,所述人均年费用可以是在参考城市中医院***(或医药***)中记录的目标药物的人均年费用。若中医院***(或医药***)中不存在该人均年费用,可以获取目标药物的历史药物年费用,然后将所述历史药物年费用除以使用人数,即可得到所述人均年费用。所述预设赔付规则可以根据所述目标药物对应的保险计划确定。具体地,服务器在得到阿昔替尼片的人均年费用时,将获取预设的阿昔替尼片保险计划,该保险计划包括赔付限额(包括上限和下限)和赔付比例,例如
赔付下限(万) 赔付上限(万) 赔付比例
0 1 95%
1 3 95%
3 5 95%
5 2000000 95%
根据阿昔替尼片的人均年费用和该保险计划的上述内容,服务器可计算所述目标药物的人均赔付参数,其中,所述人均赔付参数的计算依据以下公式:
Figure PCTCN2019095631-appb-000002
例如,阿昔替尼片的人均年费用为65090,则该阿昔替尼片的人均赔付参数X=0.95*1+(3-1)*0.95+(5-3)*0.95+(65090-5)*0.95=61835.5。
具体实施例中,当阿昔替尼片的投保计划是针对第一次投保(首 年)的客户时,该人均赔付参数还需要考虑其它的调整因素,该调整因素以一预设的首年调整因子表征,即人均赔付参数_首年=人均赔付参数*(1-首年调整因子),其中,该首年调整因子可以根据具体城市对应的实际药物使用情况进行设置。
步骤S20,根据所述目标药物对应的疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率;
本实施例中,服务器在得到阿昔替尼片的人均赔付参数时,可根据阿昔替尼片的人均赔付参数计算保险计划的风险保费;对于风险保费,是指正好用以支付赔款,因此若要计算风险保费,还需要先获取赔付事件发生的概率,即阿昔替尼片的历史赔付率。历史赔付率也就是保障病人在众多药物当中选择服用阿昔替尼片的概率。可以是根据参考城市的疾病记录和用药记录计算历史赔付率。其中疾病记录参数包括成人进展期肾细胞癌RCC患病率、诊断率、治疗率等,用药记录参数包括阿昔替尼片用药率;其中,所述历史赔付率的计算依据以下公式:历史赔付率=RCC患病率*诊断率*治疗率*阿昔替尼片用药率。
更多实施例中,若不存在所述目标药物的历史赔付率(特别是在未能获取所述目标药物在目标城市的相关记录的情况下),还可以通过对所述目标药物的用药率就行预测。具体的,服务器遍历相关文献,并从文献中获取RCC的理论发病率(适用疾病发病率)。然后依据以下公式计算得到历史赔付率:历史赔付率=RCC理论发病率*诊断率*治疗率*阿昔替尼片用药率。然后再根据阿昔替尼片的人均赔付参数、历史赔付率计算得到阿昔替尼片保险计划的风险保费,即风险保费=人均赔付参数*历史赔付率。
更多实施例中,当阿昔替尼片的保险计划是针对第一次投保(首年)的客户时,该风险保费还需要考虑市面上的竞品因素(即市面上是否存在其它治疗药物供患者选择),该竞品因素可用一预设的竞品分摊系数(0<竞品分摊系数<=1)进行表征,此时风险保费_首年=人均赔付参数*历史赔付率*竞品分摊系数。
步骤S30,获取所述目标药物的保费定价规则,并根据所述预设保费定价规则、人均赔付参数以及标准赔付率,生成所述目标药物的保费定价模型。
进一步地,步骤S30具体包括:
获取所述目标药物的保费定价规则,并获取所述目标药物对应的运营成本费用、税费比例以及目标利润;
根据所述预设保费定价规则、运营成本费用、税费比例、目标利润、人均赔付参数以及标准赔付率,生成所述目标药物的保费定价模型。
具体地,阿昔替尼片的保险计划的运营费用可理解为运营成本,其中包括***费用和人力成本,其中***费用又包括接口费用和专线费用,人力成本则为线下网点人数与平均工资的乘积。对于税费比例及利润目标,则可以是根据实际情况进行设置。服务器在得到保险计划的风险保费时,可根据业务***获取得到相关的运营费用、税费比例及利润目标信息,然后根据阿昔替尼片保险计划的保费定价的计算公式,即
保费定价=(风险保费+运营费用)/(1-税费比例-利润率目标),即可生成对应的保费定价模型。
更多实施例中,服务器在计算得到阿昔替尼片保险计划的保费定价时,可将该保费定价反馈至对应的业务终端(或投保人终端),以使得业务人员根据该保费定价进行收费(或使得投保人进行缴费)。投保人投保后,若出现理赔事件(购买使用了阿昔替尼片),可通过对应终端向服务器发送理赔请求。服务器在接收到理赔请求时,将根据阿昔替尼片的适用病种获取对应的理赔审核材料,如进展期肾细胞癌审核必备的病理学诊断或者动脉血栓栓塞诊断;然后服务器可根据上述材料判断投保人是否满足理赔条件,若满足,则可获取投保人购买阿昔替尼片的实际花费,并结合投保计划中的赔付比例计算理赔费用进行理赔。
本实施例提供一种保费定价模型的建立方法,即在接收到基于目标药物的模型建立请求时,获取所述目标药物对应的预设赔付规则以 及人均年费用,并根据所述人均年费用和预设赔付规则,计算所述目标药物的人均赔付参数;
根据所述目标药物对应的疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率;获取所述目标药物的保费定价规则,并根据所述预设保费定价规则、人均赔付参数以及标准赔付率,生成所述目标药物的保费定价模型。通过上述方式,本申请针对不同药物设定不同的预设赔付规则,并根据所述目标药物对应的实际人均年费用计算出实际人均赔付参数,然后结合目标药物的标准赔付率和保费定价规则,生成保费定价模型,提高了定价模型的定价准确度,解决了现有保费定价模型准确度低下的技术问题。
参照图3,图3为本申请保费定价模型的建立方法第二实施例的流程示意图。
基于上述图2所示实施例,本实施例中,所述步骤S20具体包括:
步骤S21,判断所述数据库中是否存在所述目标药物的疾病记录参数和用药记录参数;
本实施例中,所述疾病记录参数包括成人进展期肾细胞癌RCC患病率、诊断率、治疗率等,用药记录参数包括阿昔替尼片用药率。根据所述目标药物对应的疾病记录参数标识和用药记录参数标识,查找参考城市中医院***(或医药***)中的相关数据,以判断所述数据库中是否存在所述目标药物对应的疾病记录参数和用药记录参数。
步骤S22,若所述数据库中不存在所述疾病记录参数和用药记录参数,则获取所述目标药物对应治疗疾病的理论发病率;
本实施例中,若判断参考城市中医院***(或医药***)中不存在所述目标药物对应的疾病记录参数和用药记录参数,则通过服务器遍历相关文献,并从文献中获取RCC的理论发病率(即适用疾病发病率)。
步骤S23,根据预估赔付率调整参数和所述理论发病率,计算所述目标药物的理论赔付率,作为所述目标药物的标准赔付率,其中,所述理论赔付率的计算依据以下公式:理论赔付率=预估赔付率调整参数*理论发病率。
本实施例中,获取预估赔付率调整参数,并将理论发病率与预估赔付率调整参数相乘,从而得到理论赔付率,并将计算得到的理论赔付率作为标准赔付率,其中,所述预估赔付率调整参数可根据具体城市对应的具体药物进行对应设置。
步骤S24,若所述数据库中存在所述疾病记录参数和用药记录参数,则根据所述疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率,其中,所述历史赔付率的计算依据以下公式:历史赔付率=疾病记录参数*用药记录参数。
本实施例中,若在所述数据库中查找到所述目标药物对应的疾病记录参数和用药记录参数,即可通过公式:历史赔付率=疾病记录参数*用药记录参数,计算出所述目标药物的历史赔付率,即阿昔替尼片的历史赔付率=RCC患病率*诊断率*治疗率*阿昔替尼片用药率。
进一步地,所述若所述数据库中存在所述疾病记录参数和用药记录参数,则根据所述疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率的步骤之后,还包括:
根据所述目标药物对应的预设附加风险参数,计算所述目标药物的目标赔付率,作为所述目标药物的标准赔付率,其中,所述目标赔付率的计算依据以下公式:目标赔付率=历史赔付率*(1+预设附加风险参数)。
本实施例中,历史赔付率与预设附加风险参数相乘得到目标赔付率,其中,所述历史调整赔付率的计算依据以下公式:(目标赔付率=历史赔付率*(1+预设附加风险参数));其中,历史赔付率可理解为阿昔替尼片在理想状态下使用率,预设附加风险参数为一调整系数,可根据具体城市的目标药物的实际情况进行对应设置。
参照图4,图4为本申请保费定价模型的建立方法第三实施例的流程示意图。
基于上述图3所示实施例,本实施例中,所述步骤S10包括:
步骤S11,在接收到基于目标药物的模型建立请求时,获取所述保费定价请求中的目标城市标识;
本实施例中,服务器在接收到基于阿昔替尼片的保费计算请求时, 首先需要获取阿昔替尼片的人均年费用;值得说明的是,由于不同城市的气候、消费水平、人群特征等都有所区别,因此本案是针对不同的城市获取对应阿昔替尼片的人均年费用。对于该阿昔替尼片的人均年费用,可以是直接获取目标城市标识,并根据目标城市标识获取所述目标药物在目标城市的相关数据。具体实施例中,若不存在所述目标药物在目标城市的相关参数,还可以根据与目标城市具有相似特点的参考城市的历史数据得出(其中,该特点的“相似”可以是通过上述气候、消费水平、人群特征等维度进行衡量)。
步骤S12,根据所述目标城市标识,获取所述目标药物在目标城市的预设赔付规则,并获取所述目标药物在所述目标城市的历史药物人均年费用,作为人均年费用。
其中,所述预设赔付规则包括赔付限额和赔付比例,所述根据所述人均年费用和预设赔付规则,计算所述目标药物的人均赔付参数的步骤包括:
获取所述目标药物在所述目标城市的赔付限额和赔付比例,并根据所述人均年费用、赔付限额和赔付比例,计算所述目标药物的人均赔付参数,
其中,所述人均赔付参数的计算依据以下公式:
Figure PCTCN2019095631-appb-000003
A为人均赔付参数,i为人均年费用,j为赔付限额,k为赔付比例。
本实施例中,服务器将会获取目标药物在目标城市的历史药物费用(历史数据),该历史药费费用可以是在参考城市中医院***(或医药***)中获取得到,包括参考城市中阿昔替尼片的历史年度总费用、使用人数;根据该历史年度总费用、使用人数可计算得到参考城市中阿昔替尼片的历史人均年费用(历史人均年费用=历史年度总费用/使用人数),例如参考城市NB市中阿昔替尼片的2015年的历史年度总费用为384800元、使用人数为68人,则NB市中阿昔替尼片的历史人均年费用为56600元。具体实施例中,若服务器未能获取到参考城市的历史药物费用(不存在相关历史费用)、或者不存在相似的参考城市,则可通过预测的方式获取预估人均年费用。具体的,服务器首先将根据阿昔替尼片的使用方法、预设说明书单价和优惠慈善 计划计算理论人均年费用;例如,阿昔替尼片每盒价格为2250元,每月需使用3盒,优惠慈善计划为参保人员连续购买4个月后免费供药,则阿昔替尼片的理论人均年费用为2250*3*4=27000元。在得到理论人均年费用时,可将该理论人均年费用与一预设的预估费用调整因子相乘,并将得到的乘积作为阿昔替尼片的预估人均年费用,其中该预估费用调整因子可根据实际情况进行设置。值得说明的是,无论是上述通过参考城市的历史数据得出的历史人均年费用、还是通过说明书预测得到的预估人均年费用,都属于经验范畴的经验人均年费用,为了使得计算结果能够符合实际情况,还需要引入预设的费用附加风险因子、时间趋势因子,以表征下一保险周期可能带来的风险情况,并根据该历史人均年费用/预估人均年费用、费用附加风险因子、时间趋势因子,计算阿昔替尼片的人均年费用,即
阿昔替尼片的人均年费用=历史人均年费用/预估人均年费用*(1+费用附加风险因子)*(1+时间趋势因子)。
例如,阿昔替尼片的人均年费用=56600*(1+15%)*(1+0)=65090。
在获取到所述目标药物的人均年费用后,进一步获取所述目标药物的预设赔付规则,其中,所述所述预设赔付规则可以根据所述目标药物对应的保险计划确定。具体地,服务器在得到阿昔替尼片的人均年费用时,将获取预设的阿昔替尼片保险计划,该保险计划包括赔付限额(包括上限和下限)和赔付比例,所述人均赔付参数的计算依据以下公式:
Figure PCTCN2019095631-appb-000004
A为人均赔付参数,i为人均年费用,j为赔付限额,k为赔付比例。例如
赔付下限(万) 赔付上限(万) 赔付比例
0 5 95%
根据阿昔替尼片的人均年费用和该保险计划的上述内容,服务器可计算所述目标药物的人均赔付参数,其中,当人均年费用为4万时,即i<j,所述人均赔付参数为:A=95%*40000=38000。当人均年费用为6万时,即i>j,所述人均赔付参数为:A=95%*50000=47500。
具体实施例中,若保险计划包括多个阶段,例如,
赔付下限(万) 赔付上限(万) 赔付比例
0 1 95%
1 3 95%
3 5 95%
5 2000000 95%
其中,上述人均赔付参数的计算依据以下公式:
Figure PCTCN2019095631-appb-000005
X为人均赔付参数,当人均年费用为65090时,则该阿昔替尼片的人均赔付参数X=0.95*1+(3-1)*0.95+(5-3)*0.95+(65090-5)*0.95=61835.5。
此外,本申请实施例还提供一种保费定价模型的建立装置。
参照图5,图5为本申请保费定价模型的建立装置第一实施例的功能模块示意图。
本实施例中,所述保费定价模型的建立装置包括:
参数计算模块10,用于在接收到基于目标药物的模型建立请求时,获取所述目标药物对应的预设赔付规则以及人均年费用,并根据所述人均年费用和预设赔付规则,计算所述目标药物的人均赔付参数;
赔付率计算模块20,用于根据所述目标药物对应的疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率;
模型生成模块30,用于获取所述目标药物的保费定价规则,并根据所述预设保费定价规则、人均赔付参数以及标准赔付率,生成所述目标药物的保费定价模型。
进一步地,所述模型生成模块30包括:
参数获取单元,用于获取所述目标药物的保费定价规则,并获取所述目标药物对应的运营成本费用、税费比例以及目标利润;
模型生成单元,用于根据所述预设保费定价规则、运营成本费用、税费比例、目标利润、人均赔付参数以及标准赔付率,生成所述目标药物的保费定价模型。
进一步地,所述赔付率计算模块20包括:
参数判断单元,用于判断所述数据库中是否存在所述目标药物的疾病记录参数和用药记录参数;
发病率获取单元,用于若所述数据库中不存在所述疾病记录参数和用药记录参数,则获取所述目标药物对应治疗疾病的理论发病率;
第一计算单元,用于根据预估赔付率调整参数和所述理论发病率,计算所述目标药物的理论赔付率,作为所述目标药物的标准赔付率,其中,所述理论赔付率的计算依据以下公式:理论赔付率=预估赔付率调整参数*理论发病率。
第二计算单元,用于若所述数据库中存在所述疾病记录参数和用药记录参数,则根据所述疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率,其中,所述历史赔付率的计算依据以下公式:历史赔付率=疾病记录参数*用药记录参数。
进一步地,所述保费定价模型的建立装置还包括:
调整模块,用于根据所述目标药物对应的预设附加风险参数,计算所述目标药物的目标赔付率,作为所述目标药物的标准赔付率,其中,所述目标赔付率的计算依据以下公式:目标赔付率=历史赔付率*(1+预设附加风险参数)。
进一步地,所述参数计算模块10包括:
标识获取单元,用于在接收到基于目标药物的模型建立请求时,获取所述保费定价请求中的目标城市标识;
第三计算单元,用于根据所述目标城市标识,获取所述目标药物在目标城市的预设赔付规则,并获取所述目标药物在所述目标城市的历史药物人均年费用,作为人均年费用。
进一步地,所述参数计算模块10还用于:
获取所述目标药物在所述目标城市的赔付限额和赔付比例,并根据所述人均年费用、赔付限额和赔付比例,计算所述目标药物的人均赔付参数,
其中,所述人均赔付参数的计算依据以下公式:
Figure PCTCN2019095631-appb-000006
A为人均赔付参数,i为人均年费用,j为赔付限额,k为赔付比例。
其中,上述保费定价模型的建立装置中各个模块与上述保费定价模型的建立方法实施例中各步骤相对应,其功能和实现过程在此处不再一一赘述。
此外,本申请实施例还提供一种计算机可读存储介质,所述计算机可读存储介质可以为非易失性可读存储介质。
本申请计算机可读存储介质上存储有计算机可读指令,其中所述计算机可读指令被处理器执行时,实现如上述的保费定价模型的建立方法的步骤。
其中,计算机可读指令被执行时所实现的方法可参照本申请保费定价模型的建立方法的各个实施例,此处不再赘述。
需要说明的是,在本文中,术语“包括”、“包含”或者其任何其他变体意在涵盖非排他性的包含,从而使得包括一系列要素的过程、方法、物品或者***不仅包括那些要素,而且还包括没有明确列出的其他要素,或者是还包括为这种过程、方法、物品或者***所固有的要素。在没有更多限制的情况下,由语句“包括一个……”限定的要素,并不排除在包括该要素的过程、方法、物品或者***中还存在另外的相同要素。
上述本申请实施例序号仅仅为了描述,不代表实施例的优劣。
通过以上的实施方式的描述,本领域的技术人员可以清楚地了解到上述实施例方法可借助软件加必需的通用硬件平台的方式来实现,当然也可以通过硬件,但很多情况下前者是更佳的实施方式。基于这样的理解,本申请的技术方案本质上或者说对现有技术做出贡献的部分可以以软件产品的形式体现出来,该计算机软件产品存储在如上所述的一个存储介质(如ROM/RAM、磁碟、光盘)中,包括若干指令用以使得一台终端设备(可以是手机,计算机,服务器,空调器,或者网络设备等)执行本申请各个实施例所述的方法。
以上仅为本申请的优选实施例,并非因此限制本申请的专利范围, 凡是利用本申请说明书及附图内容所作的等效结构或等效流程变换,或直接或间接运用在其他相关的技术领域,均同理包括在本申请的专利保护范围内。

Claims (20)

  1. 一种保费定价模型的建立方法,其特征在于,所述保费定价模型的建立方法包括以下步骤:
    在接收到基于目标药物的模型建立请求时,获取所述目标药物对应的预设赔付规则以及人均年费用,并根据所述人均年费用和预设赔付规则,计算所述目标药物的人均赔付参数;
    根据所述目标药物对应的疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率;
    获取所述目标药物的保费定价规则,并根据所述预设保费定价规则、人均赔付参数以及标准赔付率,生成所述目标药物的保费定价模型。
  2. 如权利要求1所述的保费定价模型的建立方法,其特征在于,所述根据所述目标药物对应的疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率的步骤包括:
    判断所述数据库中是否存在所述目标药物的疾病记录参数和用药记录参数;
    若所述数据库中存在所述疾病记录参数和用药记录参数,则根据所述疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率,其中,所述历史赔付率的计算依据以下公式:历史赔付率=疾病记录参数*用药记录参数。
  3. 如权利要求2所述的保费定价模型的建立方法,其特征在于,所述判断所述数据库中是否存在所述目标药物的疾病记录参数和用药记录参数的步骤之后,还包括:
    若所述数据库中不存在所述疾病记录参数和用药记录参数,则获取所述目标药物对应治疗疾病的理论发病率;
    根据预估赔付率调整参数和所述理论发病率,计算所述目标药物的理论赔付率,作为所述目标药物的标准赔付率,其中,所述理论赔付率的计算依据以下公式:理论赔付率=预估赔付率调整参数*理论发病率。
  4. 如权利要求2所述的保费定价模型的建立方法,其特征在于,所述若所述数据库中存在所述疾病记录参数和用药记录参数,则根据所述疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率的步骤之后,还包括:
    根据所述目标药物对应的预设附加风险参数,计算所述目标药物的目标赔付率,作为所述目标药物的标准赔付率,其中,所述目标赔付率的计算依据以下公式:目标赔付率=历史赔付率*(1+预设附加风险参数)。
  5. 如权利要求1所述的保费定价模型的建立方法,其特征在于,所述在接收到基于目标药物的模型建立请求时,获取所述目标药物对应的预设赔付规则以及人均年费用的步骤包括:
    在接收到基于目标药物的模型建立请求时,获取所述保费定价请求中的目标城市标识;
    根据所述目标城市标识,获取所述目标药物在目标城市的预设赔付规则,并获取所述目标药物在所述目标城市的历史药物人均年费用,作为人均年费用。
  6. 如权利要求5所述的保费定价模型的建立方法,其特征在于,所述预设赔付规则包括赔付限额和赔付比例,所述根据所述人均年费用和预设赔付规则,计算所述目标药物的人均赔付参数的步骤包括:
    获取所述目标药物在所述目标城市的赔付限额和赔付比例,并根据所述人均年费用、赔付限额和赔付比例,计算所述目标药物的人均赔付参数,
    其中,所述人均赔付参数的计算依据以下公式:
    Figure PCTCN2019095631-appb-100001
    A为人均赔付参数,i为人均年费用,j为赔付限额,k为赔付比例。
  7. 如权利要求1所述的保费定价模型的建立方法,其特征在于,所述获取所述目标药物的保费定价规则,并根据所述预设保费定价规则、人均赔付参数以及标准赔付率,生成所述目标药物的保费定价模型的步骤包括:
    获取所述目标药物的保费定价规则,并获取所述目标药物对应的运营成本费用、税费比例以及目标利润;
    根据所述预设保费定价规则、运营成本费用、税费比例、目标利润、人均赔付参数以及标准赔付率,生成所述目标药物的保费定价模型。
  8. 一种保费定价模型的建立装置,其特征在于,所述保费定价模型的建立装置包括:
    参数计算模块,用于在接收到基于目标药物的模型建立请求时,获取所述目标药物对应的预设赔付规则以及人均年费用,并根据所述人均年费用和预设赔付规则,计算所述目标药物的人均赔付参数;
    赔付率计算模块,用于根据所述目标药物对应的疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率;
    模型生成模块,用于获取所述目标药物的保费定价规则,并根据所述预设保费定价规则、人均赔付参数以及标准赔付率,生成所述目标药物的保费定价模型。
  9. 如权利要求8所述的保费定价模型的建立装置,其特征在于,所述模型生成模块包括:
    参数获取单元,用于获取所述目标药物的保费定价规则,并获取所述目标药物对应的运营成本费用、税费比例以及目标利润;
    模型生成单元,用于根据所述预设保费定价规则、运营成本费用、税费比例、目标利润、人均赔付参数以及标准赔付率,生成所述目标药物的保费定价模型。
  10. 如权利要求8所述的保费定价模型的建立装置,其特征在于,所述赔付率计算模块包括:
    参数判断单元,用于判断所述数据库中是否存在所述目标药物的疾病记录参数和用药记录参数;
    发病率获取单元,用于若所述数据库中不存在所述疾病记录参数和用药记录参数,则获取所述目标药物对应治疗疾病的理论发病率;
    第一计算单元,用于根据预估赔付率调整参数和所述理论发病率,计算所述目标药物的理论赔付率,作为所述目标药物的标准赔付率,其中,所述理论赔付率的计算依据以下公式:理论赔付率=预估赔付 率调整参数*理论发病率。
    第二计算单元,用于若所述数据库中存在所述疾病记录参数和用药记录参数,则根据所述疾病记录参数和用药记录参数,计算所述目标药物的历史赔付率,作为所述目标药物的标准赔付率,其中,所述历史赔付率的计算依据以下公式:历史赔付率=疾病记录参数*用药记录参数。
  11. 如权利要求10所述的保费定价模型的建立装置,其特征在于,所述保费定价模型的建立装置还包括:
    调整模块,用于根据所述目标药物对应的预设附加风险参数,计算所述目标药物的目标赔付率,作为所述目标药物的标准赔付率,其中,所述目标赔付率的计算依据以下公式:目标赔付率=历史赔付率*(1+预设附加风险参数)。
  12. 如权利要求8所述的保费定价模型的建立装置,其特征在于,所述参数计算模块包括:
    标识获取单元,用于在接收到基于目标药物的模型建立请求时,获取所述保费定价请求中的目标城市标识;
    第三计算单元,用于根据所述目标城市标识,获取所述目标药物在目标城市的预设赔付规则,并获取所述目标药物在所述目标城市的历史药物人均年费用,作为人均年费用。
    其中,所述参数计算模块还用于:
    获取所述目标药物在所述目标城市的赔付限额和赔付比例,并根据所述人均年费用、赔付限额和赔付比例,计算所述目标药物的人均赔付参数,
    其中,所述人均赔付参数的计算依据以下公式:
    Figure PCTCN2019095631-appb-100002
    A为人均赔付参数,i为人均年费用,j为赔付限额,k为赔付比例。
  13. 一种保费定价模型的建立设备,其特征在于,所述保费定价模型的建立设备包括处理器、存储器、以及存储在所述存储器上并可被所述处理器执行的计算机可读指令,其中所述计算机可读指令被所述处理器执行时,实现如权利要求1所述的保费定价模型的建立方法 的步骤。
  14. 一种保费定价模型的建立设备,其特征在于,所述保费定价模型的建立设备包括处理器、存储器、以及存储在所述存储器上并可被所述处理器执行的计算机可读指令,其中所述计算机可读指令被所述处理器执行时,实现如权利要求2所述的保费定价模型的建立方法的步骤。
  15. 一种保费定价模型的建立设备,其特征在于,所述保费定价模型的建立设备包括处理器、存储器、以及存储在所述存储器上并可被所述处理器执行的计算机可读指令,其中所述计算机可读指令被所述处理器执行时,实现如权利要求3所述的保费定价模型的建立方法的步骤。
  16. 一种保费定价模型的建立设备,其特征在于,所述保费定价模型的建立设备包括处理器、存储器、以及存储在所述存储器上并可被所述处理器执行的计算机可读指令,其中所述计算机可读指令被所述处理器执行时,实现如权利要求4所述的保费定价模型的建立方法的步骤。
  17. 一种计算机可读存储介质,其特征在于,所述计算机可读存储介质上存储有计算机可读指令,其中所述计算机可读指令被处理器执行时,实现如权利要求1所述的保费定价模型的建立方法的步骤。
  18. 一种计算机可读存储介质,其特征在于,所述计算机可读存储介质上存储有计算机可读指令,其中所述计算机可读指令被处理器执行时,实现如权利要求2所述的保费定价模型的建立方法的步骤。
  19. 一种计算机可读存储介质,其特征在于,所述计算机可读存储介质上存储有计算机可读指令,其中所述计算机可读指令被处理器执行时,实现如权利要求3所述的保费定价模型的建立方法的步骤。
  20. 一种计算机可读存储介质,其特征在于,所述计算机可读存储介质上存储有计算机可读指令,其中所述计算机可读指令被处理器执行时,实现如权利要求4所述的保费定价模型的建立方法的步骤。
PCT/CN2019/095631 2018-12-13 2019-07-11 保费定价模型的建立方法、装置、设备及存储介质 WO2020119112A1 (zh)

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