InsuranceSettlement与 DIP/DRG Datasets

{
  "claim_id": "CLM-2025-S4F8P2R7T9",
  "insurance_type": "城乡Resident基本Medical保险",
  "visit_date": "2025-04-02",
  "visit_type": "Outpatient慢特病",
  "institution_level": "Level 2",
  "institution_type": "Associate DegreeHospital（Endocrinology）",
  "primary_diagnosis": "E11.901",
  "primary_diagnosis_name": "2型Diabetes，不伴有并发症",
  "drg": {
    "mdc": "KS1",
    "adrg": "KS1",
    "drg_code": "KS19",
    "drg_name": "Diabetes，伴Merge症与并发症",
    "relative_weight": 0.62
  },
  "dip": {
    "dip_group_code": "E11.9-MZ",
    "dip_group_name": "2型Diabetes-Outpatient慢特病",
    "score": 24.5,
    "settlement_point_value": 85.50
  },
  "expenses": {
    "total_cny": 562.80,
    "yibaotongchou_cny": 393.96,
    "gerenzifu_cny": 168.84,
    "gerenzifei_cny": 0,
    "drug_cny": 468.50,
    "exam_cny": 94.30
  },
  "drug_items": [
    {"yb_code":"XN00000000001","drug_name":"Metformin Hydrochloride Tablets","form":"Tablet","spec":"0.5g","price_standard":0.15,"dosage":"0.5g bid"},
    {"yb_code":"XN00000000002","drug_name":"阿卡波糖片","form":"Tablet","spec":"50mg","price_standard":0.45,"dosage":"50mg tid"}
  ],
  "version": "2025Q1",
  "quality_score": 96.8
}

{
  "claim_id": "CLM-2025-P7A4S8T2R5",
  "insurance_type": "城TownEmployee基本Medical保险",
  "admission_date": "2025-02-15",
  "discharge_date": "2025-02-22",
  "actual_los_days": 7,
  "institution_level": "Level 3",
  "institution_type": "综合Hospital",
  "primary_diagnosis": "K80.101",
  "primary_diagnosis_name": "GallbladderStone伴ChronicGallbladder炎",
  "secondary_diagnoses": ["I10.x05","E78.501"],
  "procedures": ["51.2300"],
  "procedure_name": "Laparoscope下Gallbladder切除术",
  "drg": {
    "mdc": "HC2",
    "adrg": "HC2",
    "drg_code": "HC23",
    "drg_name": "LaparoscopeGallbladder切除术，伴Merge症与并发症",
    "relative_weight": 1.15,
    "base_rate": 12000.00
  },
  "dip": {
    "dip_group_code": "K80.1+51.23",
    "dip_group_name": "GallbladderStone伴Gallbladder炎+LaparoscopeGallbladder切除术",
    "score": 142.0,
    "settlement_point_value": 85.50
  },
  "expenses": {
    "total_cny": 15823.60,
    "yibaotongchou_cny": 11076.52,
    "gerenzifu_cny": 4247.08,
    "gerenzifei_cny": 500.00,
    "drug_cny": 3200.00,
    "exam_cny": 2100.00,
    "treatment_cny": 7023.60,
    "consumable_cny": 3500.00
  },
  "version": "2025Q1",
  "quality_score": 98.0
}

{
  "yb_code": "XN00000000003",
  "drug_name": "Injection用奥美拉唑钠",
  "form": "Injection剂（Lyophilized Powder）",
  "spec": "40mg",
  "drug_category": "西药",
  "yb_class": "Category B",
  "payment_standard_cny": 28.50,
  "restriction": {
    "scope": "限有禁食Medical Order或吞咽困难Patient的短期Treatment",
    "max_days": 14,
    "hospital_level_min": "Level 2"
  },
  "prior_self_pay_ratio": 0.10,
  "atc_code": "A02BC01",
  "pharmacological_class": "质子泵抑Formulation",
  "version": "2025Q1"
}

{
  "dip_group_code": "I63.9+00.00",
  "dip_group_name": "脑梗死-内科Treatment",
  "core_condition": "主要Diagnosis I63.9（脑梗死）且无Surgery操作",
  "score": 98.5,
  "settlement_point_value": 96.80,
  "avg_cost_cny": 9725.30,
  "avg_los_days": 10.2,
  "patient_age_range": "45-92",
  "complications_included": ["I10(高Blood Pressure)","E11(2型Diabetes)","E78(Hyperlipidemia)"],
  "version": "2025Q1"
}