The Design And Implementation Of Medical Insurance Fund Measurement And Settlement System Based On DRG

In recent years,our country’s economy has continued to develop,and the pressure on medical insurance fund expenditures has increased,and medical expenses have increased unreasonably.Diagnosis Related Groups(DRG)payment is a way that patients in each group pay medical expenses to the hospital according to a fixed standard.In 2019,our country has identified 30 cities as pilot cities for DRG payment.In October of the same year,the National Medical Insurance Bureau officially announced two technical standards,"National Medical Security DRG Grouping and Payment Technical Specifications" and "National Medical Security DRG Grouping Plan",marking that our country’s medical insurance DRG payment pilot has officially entered the implementation stage.Prior to this,there were many versions of DRG calculation and payment systems developed by scientific research institutions and medical institutions,and the technical standards were quite different.The payment standards were not calculated in accordance with the technical standards issued by the state.The medical market needs the implementation of DRG-related systems that comply with national standards to promote to complete the DRG payment reform work.On the basis of medical institutions and existing information on the construction of health care institutions,design and implementation of the health insurance fund is estimated that the settlement system based on DRG for reform measure DRG payment and pay the standard medical expense settlement.The traditional medical insurance system adopts a single architecture,which has poor scalability and high coupling,which cannot meet the needs of frequent changes in the current payment method reform functions.The microservice architecture splits the system as a whole,and each split service does not depend on other services,so that the system has higher scalability and stability.The system uses the microservice architecture for development.This paper investigates the needs of medical institutions and medical insurance institutions on DRG payment measurement and settlement.The system is divided into medical insurance fund measurement subsystem and medical insurance fund settlement subsystem,which is implemented for different users with different functions.Users of medical insurance institutions use the medical insurance fund measurement subsystem based on DRG to calculate the grouped data of cases in the past three years,calculate the weight of the current year,and then formulate a weighting plan to calculate the hospitalization expenses for the current year,and then calculate it based on the weights and total hospitalization expenses rates,formulate a rate plan,and finally calculate the payment standard for each DRG group.The user can use the payment standard to make a simulated payment,and then adjust the fee rate according to the simulated payment result.Medical insurance institution users use the medical insurance fund settlement subsystem based on DRG grouping to settle medical insurance fund settlement of cases.Medical insurance institution users review the grouped real cases,upload them to the medical insurance system,and confirm settlement.Cases that are not applicable for DRG payment can be handled as special cases.Hospital institution users can view the case settlement status of their institution and apply for special cases.The medical insurance fund measurement and settlement system based on DRG grouping studied in this paper adopts the B/S design architecture model,which can be accessed by users through a browser.The system design adopts the idea of micro-service architecture,uses JAVA language to program and develops,and comprehensively applies various open source technologies such as MyBatis and Redis.Microservice components include the use of Eureka to implement service registration discovery center,use Config Server to implement service management,use Spring Cloud Gateway to implement routing gateway services,and integration of Feign and Hystrix in the gateway to implement load balancing and service fault tolerance.Business services are designed and implemented using the MVC model,using a development model that separates the front and back ends,and finally realizes a DRG group-based medical insurance fund measurement and settlement system that integrates multiple functions such as group management,weight calculation,rate calculation,and payment settlement.This system has good disaster tolerance,security and maintainability,and has good application value.