| dc.description.abstract | Maintaining a financial balance given limited medical payments is essential for health insurance payment units and hospitals. The Bureau of National Health Insurance (BNHI) implemented the Prospective Payment System of the Global Budget System to assist hospitals in planning and controlling medical care costs and service quality. Meanwhile, the BNHI also devised various plans for strengthening the operational utilization of medical resources, such as Case Payment System. This system has two types of orders; one is basic required examinations and treatments, and the other is option. In this Case Payment System, hospitals must execute 65% basic required examinations and treatments. Under this condition, it is impossible to understand how ‘65% of basic required examinations and treatments’ are calculated? Is the ‘35% of exanimations and treatments’ unimportant? This study suggested SFLI (standing for Suitable and Frequent Large Itemsets) algorithm to solve the suitable number of necessary medical order items. The algorithm was based upon decomposition. Prototyping and Similar Basic Order Group (BOG) were generated by SFLI and SOM algorithm respectively. Acting on relative strength, approach value and value rate, draft BOG were generated using these Prototyping BOG and Similar BOG. The SFLI algorithm employed decomposition method. This makes the suitable frequent and large itemsets processed faster, and reduced CPU time of no generating candidate itemsets. Therefore, this performance was the more better of the Apriori and FP_Tree algorithm. Meanwhile, the inside of the draft BOG’s elements, which are order items, were allowed to employ a reporting fee to calculate the payments of every draft BOG. This study compared and tested statistical hypotheses between the experiment contrast payment for every draft BOG and the health insurance reporting payments of each hospital level. Through verification of different rate, draft BOG were transformed to BOG that had full of cost-benefit. Therefore, the BOG can not only assist payment units in reducing costs, but also can assist hospitals in operating efficiently using the Fixed Amount System. Consequently, this study demonstrates a standard of payment for current and future basic and suitable order items of Fixed Amount System references. | en_US |