진료비 청구 삭감 분석시스템 구현을 위한 데이터마이닝기법 활용에 관한 연구

박문로*1), 전효찬1), 김윤년2), 유상진3)

1)계명대학교 보건의료정보기술연구소
2)계명대학교 의과대학 의료정보학교실
3)계명대학교 경영대학 경영정보학과

Abstract : Today, all kinds of profit organizations are facing such dynamic competitive environment as globalization, informatization, and specialization. Organizations that want to survive from fierce competition must be able to cope with these new environment. In other words, organizations may not be guaranteed the survival unless maintaining their own competitive advantage. Hospitals are not the exception. thus, hospitals put their efforts continuously to develop tools and weapons to achieve and maintain the competitive advantage. The claim reduction system for hospital bills is one of the effective competitive weapons. Although the system is designed and developed to increase the hospital's revenue stream by cutting down the rejection rate, many success stories are not reported. Poor implementation, inaccurate data and the lack of user involvement could be cited as the reason. Thus, a better designed system need to be developed to fulfill the goal of the claim reduction system. For this purpose, an alternative system utilizing data mining technique and relation rules algorithm is developed and implemented.
keyword : claim reduction system, data mining, relation rules algorithm

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