編譯器技術應用於醫療費用申報檔案之檢核

Correctness Check of the Claim Data with Compiler Technology

姚冠睿(Yao, Guanrui)

指導教授 ： 吳帆 ； 胡雅涵

國立中正大學/管理學院/資訊管理系醫療資訊管理研究所/碩士(2013年)

摘要

根據中央健康保險局的歷年報表，全民健康保險財政部份長期處於赤字的狀態。最直接影響健保支出的即是各特約醫事服務機構所申請的醫療服務費用。目前在醫療服務費用申報檔案審查上普遍使用SQL command方法來進行。但是使用SQL command方法進行審查有著執行上太過費時的缺點。此時，我們注意到被使用在許多領域的編譯器技術，它具有優異的偵錯能力與執行速度。因此在本研究中。我們使用編譯器的偵錯技術為基本概念，建立一個新的醫療服務費用申報檔案審查方法來減少審查時所耗費的時間及提升審查效率。我們將申報的每筆資料當作code、醫療服務費用支付規則與醫療服務醫令規定轉換為文法，利用編譯器技術來進行審查。在最後的模擬結果中，本篇所提出的編譯器技術應用之審查方法很明顯地減少了執行時間及大幅提升審查效率。

關鍵字

醫事服務申報 ； 編譯器 ； 偵錯 ； 審查

並列摘要

According to the financial statements over the years, Bureau of National Health Insurance’s account has been being in the red for a long time. The medical care service declaration from medical care institutions affects BNHI’s expenditure directly. In general, we use SQL command method to check the claim data. But there is a disadvantage to use SQL command method which expends too much time. At this moment, we notice the compiler technology, which has great error-detection capability and speed of execution, has been used in many areas to detect the errors. Because of its advantages, we use the compiler’s error-detection technology to be the basic concept to propose a new medical care service declaration checking system. With the proposed system, we reduce the time-consumed and promote efficiency. We make every medical care service claim data as codes and translate the declaration rules into grammars, and then we use compiler’s error-detection technology to examine the claim data. In the simulation results, the checking system with compiler technology method spends the time less than SQL command method obviously.

並列關鍵字

medical care service declaration ； compiler technology ； error-detection

參考文獻

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