Construction of a precise supervision mechanism for medical insurance dual-channel drugs based on collaborative filtering algorithm in the era of intelligent medical insurance
Bibliographic record
Abstract
In recent years, China's health insurance drug negotiation has become increasingly improved, and the speed of access to the health insurance catalog has increased dramatically.Under the implementation of health insurance negotiated drugs and dual-channel policy, this study investigates the application of negotiated drugs in a certain region to explore their accessibility and affordability.On this basis, it links the health insurance department, designated pharmacies and medical institutions to explore the precise regulatory mechanism of dual-channel drugs in health insurance.For the drug safety supervision therein, collaborative filtering algorithms, attention mechanisms and multi-task learning are utilized to construct an adverse drug reaction prediction model.It is found that under the influence of the health insurance dual-channel policy, the accessibility and affordability models of medicines are enhanced, the types of negotiated medicines, the number and total amount of purchases are increased year by year, and the total amount of purchases by medical institutions and retail pharmacies are enhanced by 3.42 times and 2.36 times, respectively.The proposed prediction model has good accuracy and applicability in predicting adverse drug reactions, with AUC and AUPR values of 0.93 and 0.83 on different datasets, which are better than the comparison methods.It is recommended to continuously promote the construction of the "dual-channel" management mechanism of designated medical institutions and retail pharmacies to enhance the convenience and sense of access to medical care of the insured.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".