Research On Risk Prevention And Control Of Guiyang Medical Insurance Fund Based On Data Mining Technology

In recent years, with the increasing of national income and social securitysystem’s coverage, the medical insurance fund scale was huger and huger. Thenational medical insurance fund’s income and expenditure were raised annually, andthe balance of payments was also expanding, the accumulated balance the end of eachyear was increasing. With the continuous of national medical insurance, the medicalinsurance personnel increased dramatically, health care was more and more complex,the amount of data raised rapidly. From point of macroscopic view, the sources ofmedical insurance fund were much more uncertain, total expenditure raised constantly,the approach of “balance of payments, a slight surplus” was difficult to guarantee; inmicroscopic scales, individual and expense behavior were hard to control, medicalinsurance designated pharmacies, hospitals’ nonstandard action were also occurred,which was particularly important for the research of medical insurance fund riskprevention and control. In addition, the computer technology and network technologywere developing, large-scale database systems were widely used, so that the healthcare information technology was more and more perfect. Vast amount of data existedin the database, data mining techniques were followed, and they laid the techniquesfoundation for the research of medical risk prevention and control.In this paper, Guiyang City social medical insurance business as the background,urban residents social medical insurance fund payment information in Guiyang Cityand the social medical insurance fund of personal account in a city as the data sources,built a data warehouse based on Oracle platform, and used Oracle software OWB(Oracle Warehouse Builder), Oracle BIEE (Business Intelligence), Oracle Data Minerto build data warehouse themes, OLAP and study the data mining.This paper described the background, meaning, purpose of the topic and the statusof research at home and abroad, and summarized the social security of China, datamining, risk management and other related techniques. After studying the relatedtechnologies, contents and the business of social medical insurance in social security,designed the warehouse of the urban residents medical insurance fund, the urbanresidents single disease expenses and the total revenues of personal account detailed,and determined the design goals, design description and technique architecture. Itexplored the realization of those three themes which based on Oracle data warehouse platform, studied the data warehouse’s physical model, logical model, construction ofOLAP database and data mining. Ultimately, data mined, analyzed, forecasted forthose themes of the urban residents medical insurance fund, the urban residents singledisease expenses and the total revenues of personal account, drew several conclusionsof the medical insurance fund risk prevention.