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A Study on the Development and Implementation of a Data-mining Based Prototype for Hospital Bill Claim Reduction System  

Yoo, Sang-Jin (Department of MIS, Keimyung University)
Park, Mun-Ro (Division of Information Systems, Dong San Medical Institute)
Publication Information
Information Systems Review / v.7, no.1, 2005 , pp. 275-295 More about this Journal
Abstract
Changes in business environment caused by globalization of the world economy and the beginning of the knowledge society forced hospitals to equip with tools for the enhanced competitiveness. In other words, hospitals must aim three targets such as acquisition of advanced medical skills and equipments, improvement of service level for patients, and achievement of superior managerial performance simultaneously. This study has been done to suggest a way to reduce the possibility of hospital bill claim reduction as an alternative for the achievement of superior managerial performance. If the reduction rate of hospital bill claim is high, it will put negative impact on the hospital's revenue stream and hospital's reliability. Thus, if they want to stay competitive, hospitals need to device ways to cut the reduction rate as much as possible. In this study, a prototype system has been developed and implemented to check the possibility to cut the reduction rate through deep analysis of causes of reduction. The prototype first developed utilizing data mining techniques and the relation rules algorithm. Then the prototype was tested its performance using the D hospital's live data.
Keywords
Data Mining; National Health Insurance; Hospital Bill; Claim Reduction System;
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