Issues about subsiding dental orthodontics considering trust degree of dentists in insurance claim

• Main Authors: WANG SHU-LI, 王淑莉
• Other Authors: WU,MEI-FANG
• Format: Others
• Language: en_US
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/3e289c

博士 === 逢甲大學 === 工業工程與系統管理學系 === 107 === Orthodontic treatment is to cure malocclusion, which is a very common oral dis-ease. The chewing habit in the modern life has caused the ratio of malocclusion to increase, especial for the young people with high degree of urban life style. Or-thodontics is the effective treatment for malocclusion that can re-arrange the teeth and then improve the chewing function as well as the appearance of the face and reduce the expenses for cavity and dental tartar. The processes of orthodontics are clinical and technological issues. In the past, most of the researches about the orthodontics are related to the clinical and technological topics. The researches for the dentist-patient relationship, dental insurance, and dental data analysis are rare. This study explores the about issues, and it is consisted of three parts: the first one is to collect the orthodontic data from hospitals and open data from government, this study presented the descriptive statistics about the orthodontic operations, discovering the facts that the expenses for tooth decay, periodontal diseases and so on; the second part is to discuss the dentist-patient communica-tion; the third is to explore the ways to detect the fraudulent dental claims. From investigating the collected data about the orthodontic, we can see not only the high cost but also the long period to perform the orthodontic treatment. From the government data and our survey, the study found that the expenses for the cavity, periodontal diseases, etc, caused by the malocclusion occupied up to a half of all the expenses for the dental treatment. The orthodontic fee cannot be reimbursed until now. In the viewpoint of preventive medicine, if the reimbursement for or-thodontics by National insurance is admitted, the health of the populations can be increased and the expenses for the dental diseases can be reduced. However, the fraudulent claims are inherent problems existing in insurance, so is to the den-tal department. This paper proposed a trust evaluation for dentists. With the cur-ing order for a same patient among several dentists, the paper can construct the social network among the dentists for detecting the faulty claims. In detail, for a same dental operation of a same patient, the paper can compute the trust degree of the related dentists according to the repetition, necessity, and complexity of the dental operation. For evaluating the correctness of the proposed method, we generated the simulated claiming data under the reasonable scenarios. In addition, we conducted several experiments with empirical data to evaluate the correctness of our method. The simulation results and empirical results all agree with the ex-pectation of the proposed method. With the proposed method, it is expected that the detection of the faulty claims can be executed efficiently, achieving the fair-ness among the dentists under the policy of global budget.