The Control Technology of Medical Expenses: A Combination of Data Mining and Quality Control Chart

Abstract

This study proposes a technique to improve expense control in the medical industry. It focuses on the Diagnosis Related Groups and uses Data Mining to study the issue of medical insurance premium in Taiwan. We are focusing on sample data to conduct analytical methods like the descriptive statistics, and the actual upper-to-lower limits of medical claim is defined with reference to the reasonable upper and lower limit control chart set by the National Health Insurance Administration. Then with decision tree, the reported expenses of the medical system is grouped and forecasted to determine the differences and rationality of medical expenses and then in turn, determine the correlation between the hospital operating procedures and medical treatment expenses, find the impact factors and countermeasures for optimized expense to conduct further improvements and in the same time, reasonably regulates and monitors medical personnel’s expense claims to prevent the further waste of medical resources.