現行醫療保險理賠申請流程相當繁複，被保險人需要向醫療機構申請診斷證明，填具理賠申請書向保險公司提出理賠申請，再由保險公司進行審核。若遇到無法從診斷書直接審核之個案，保險公司需先取得被保險人簽署之調閱病歷同意書後，方能至醫療機構調閱病歷，以利後續理賠審核。這樣的流程，對保險公司來說，需耗費大量人工成本；對被保險人來說，則也有資訊不夠透明的疑慮。
區塊鏈的運作有著公開透明，且難以造假的不可否認性。智能合約是在區塊鏈平台上執行的協議落實程式，既能確保程式不會被竄改，又可保留所有執行紀錄。若能透過這些特性來做為醫療保險理賠傳遞訊息的媒介，除了能提昇保險公司審核流程的時效性，被保險人也能獲得公開透明的資訊。
本論文提出了一套基於智能合約來實現快速醫療保險理賠的方案，我們在以太坊上實作智能合約，我們的方案除了能改善現有的問題，也建構出一套公開透明，且兼顧病人隱私的理賠系統，並考量實際狀況，讓保險公司的業務邏輯可以重用，在理想與現實之間取得一個適當之平衡點。 / Current medical insurance claims application process is complex. It requires the insured to apply for medical diagnosis, and to fill out an application form to the insurance company. The insurance company then reviews the case. If they are unable to approve the claims, they must first obtain the consent form from the insured in order to access to his or her medical records to facilitate subsequent claims review. Throughout the process, the insurance company needs to pay a lot of labor costs; while the insured will have many concerns of information transparency.
Blockchain operates in an open and transparent manner and maintains its data in a tamper-free way. Smart contracts are programs executed on a blockchain platform to enforce an agreement such that the program will not be tampered with, and all records of execution will be kept from modification. These characteristics of a smart contract make it very good as a tool for streamlining the medical insurance claims process, as it will greatly reduce the human efforts involved on the insurance company side while increase the information transparency from the perspective of the insured.
This thesis presents a smart contract based solution for streamlining the medical insurance claims process. We design and implement the con-tract on the Ethereum platform. In addition to improving the existing problems, our solution builds an open and transparent claims system that takes into account the patient privacy and the practical requirement of re-using the existing claims processing system of the insurance company, thus achieving a proper balance between the ideal and reality.
| Identifer | oai:union.ndltd.org:CHENGCHI/G0103971020 |
| Creators | 林展民, Lin, Chan Min |
| Publisher | 國立政治大學 |
| Source Sets | National Chengchi University Libraries |
| Language | 中文 |
| Detected Language | English |
| Type | text |
| Rights | Copyright © nccu library on behalf of the copyright holders |
Page generated in 0.0088 seconds