Renmin Hospital of Wuhan University

Renmin Hospital of Wuhan University introduced artificial intelligence into health insurance operations management. It selected the evaluation indicators of DRG-based health insurance payment, together with a number of clinical departments, as modeling samples. On that basis it built a DRG reimbursement model using a back-propagation (BP) neural network. The model addresses a weakness of traditional methods, which select the network structure from experience; it allows the network structure, weights and thresholds to be determined more accurately.

Working from the model, the hospital shows the clinical service level of each department across several dimensions, so that problems are identified early and targeted improvements follow. It concentrates management attention on loss-making case groups, tracking and analyzing resource consumption and identifying its strong specialties and case types. It also curbs unreasonable medical expenses, forecasting, planning, controlling, analyzing and assessing service costs in order to improve the efficiency of health insurance fund use.