The Design And Implementation Of The Medical Costs Control System Of The Social Medical Insurance Based-on Rule

With the enlargement of the basic insurance of medical care, the components of its participants are becoming more and more complex. Meanwhile, the form and means of medical service are developing too, which makes the social basic insurance of medical care face the great pressure that the fund expenditure is increasing with high speed. However, among the growth, quite a lot parts are resulted from the misappropriation and embezzlement by the dishonesty of medical service in medical service institution and the poor moral level among participants. Therefore, it has become an urgent requirement to discriminate the excessive consumption of medical act and even the vicious use of insurance fund, to control the medical costs, to ensure the quality of medical treatment through using the information technology to watch on the behavior of medical service institutions and the participants.Business Rule Management (BRM) will deal with the business logic as the object of structure to make the complex business become a simple business rule and to make the logic relation among business rule be dealt by rule program. BRM will change the way of referring the business logic to the process form, which will free the business rule from concrete program code to express specific business act through the structuralized business rule, and it will let the business rule and the basic data information become important assets of institutions.Through a design which realized the medical costs control system of the Social Medical Insurance, the assay explored a new method based on the business rule by integrating J2EE, Rule Engine, JDBC, XML and other technology, which make the systematic structure clear, have good expansibility,maintainability and platform independence.Firstly, the assay thoroughly analyzed the needs of medical costs control business, defined the business facts and categories, basic technical terms and manifestation of the rules, so as to build up a knowledge base for the medical costs control business. Then it studied the flow path of business rule system, analyzed the present rule engines of work processes, and selected the best one– Drools to satisfy the business requirements, which ensures the system high efficiency and stability. And then it designed and realized a clear, logical and easy to manage and maintain rule relation storage structure based on the pervious studies. It also realized the editing function of the rules which truly satisfied the demand of defining the rules by businessmen themselves. The author has been engaged in designing and developing the Social Insurance Info-system with ages of experience. He can master some visionary demands of the Social Insurance business timely and exactly, and then realize them by relevant technology. The author will study the Social Insurance as always and make more contributions to the constantly perfect Social Insurance Info-system in the future study and work.