Research on Settlement System Based on Rule Engine under Chinese Regional Medical Mode

As the development of medical reform, the social medical insurance system is built and improved. The construction of a proper and efficient pay mode is becoming more and more important. PPS-DRGs (Prospective Payment System based on Diagnosis Related Groups) has been applied in medical insurance system by many nations, and got good effects. But in China, PPS-DRGs is staying in the pilot phase and has not been built a sophisticated application system. Especially in the environment of regional medical mode which is advocated by the new medical reform plan, PPS-DRGs is confronted with some new challenges such as settlement between different hospitals. This paper focuses on the settlement system under regional medical mode, in which the rule engine technology is used to mange the rules of payment. Such technology separates the codes and rules, which leads to the flexible change and adjustment of settlement mode, and thereby improves the efficiency of regional medical system.