品質工学
Online ISSN : 2189-9320
Print ISSN : 2189-633X
ISSN-L : 2189-633X
事例研究
MTシステムによる適正レセプトの評価
―単位空間メンバーが1つの場合の評価法―
矢野 耕也中島 尚登長澤 薫子小林 英史横田 邦信松平 浩上竹 慎一郎高木 一郎
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2018 年 26 巻 2 号 p. 35-42

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Medical care starts with an examination to diagnose the disease, continueswith tests, treatments, medication, and other medical procedures, and concludeswith the billing and payment process. The payment process is based onan insurance claim filed by the care provider. Checking that the claim conformswith the diagnosis is not a simple matter, because each patient has a differentset of conditions, and the information in the claim varies accordingly. Whenthere is no clear standard, as with these claims, there is little point in constructingmultiple standard unit spaces. A method that reduces the n standardunit spaces used for one type of claim to a single unit space and evaluatingclaims by the transferability S/N ratio was therefore adopted. As a result, a correspondencewas observed between the patient’s condition and the S/N ratioeven when there was only one unit space data set, and numerical evaluation ofthe claims became possible.

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