The Data Mining And Data Analysis In The Expense Of Insured Patients For Medical Treatment

With rapid reformation in China’s medical system, the proportion of the state healthinsurance individuals within total patients is increasing throughout times, and the healthinsurance becomes an important source of revenue for the hospitals. Therefore, themanagement for the health insurance could not be simply ignored. Currently, there are someissues incurred within the management for the state health insurance, for examples: how tocontrol the raise of the cost of medical treatment for insured patients without lowering qualityof their medical services; how to reasonable allocate resources returned by the healthinsurance, in order to design efficient health insurance budget plan; how to improve themotivation of professional staffs, which leads to a better implement for the health insurancepolicies. According to observed China state health insurance problems, we obtain an analysisfor health insurance database in the hospitals through data mining, as today the majority ofhospital in China has established the Hospital Information System (HIS), and gained a relativesufficient database. The traditional statistical technology and data management tools cannotsatisfy the needs for analytical work of large database, thus, the Data Mining (DM) andKnowledge Discovery Database (KDD) has been developed for this purpose.Basing on Data Warehouse (DW) and DM, this dissertation contains following points:1. Identifying the medical cost for patients covered by health insurance as the goal ofthis analysis.2. After a lager amount of repetitive data cleaning, three annual database for the statehealth insurance are extracted from the HIS, which then are used for building DW andrelated multidimensional data models. This improves the presentation and flexibility of thestate health insurance analysis.3. Drawing conclusions from generation data mining for multidimensional data models,by using association rules.4. According to the conclusions from point3, offering suggestions that instead offorming payment method based on the number of patients for a certain type of medicaltreatment, it would be less burdens for the hospital and patients to form payment methodaccording the type of medical treatments.