344 lines
15 KiB
Python
344 lines
15 KiB
Python
# -*- coding: utf-8 -*-
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"""
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主数据模块
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"""
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import sys
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from datetime import datetime
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from decimal import ROUND_HALF_UP, Decimal
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from pathlib import Path
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from typing import Any, Dict, List, Optional
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sys.path.append(Path(__file__).parent.parent.as_posix())
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from utils.sqlite import SQLite
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class MasterData(SQLite):
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"""
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主数据，支持：
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query_liabilities：根据保险分公司名称、被保险人姓名、证件类型、证件号码和报案时间查询被保险人的理赔责任
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query_institution_type：根据购药及就医机构名称查询购药及就医机构类型
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query_medicine：根据明细项中具体内容查询药品/医疗服务名称
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"""
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def __init__(self, database: Path):
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"""
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初始化
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:param database: 数据库路径
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"""
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# 初始化SQLite客户端
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super().__init__(database=database)
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try:
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with self:
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# 初始化团单表
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self.execute(
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sql="""
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CREATE TABLE IF NOT EXISTS group_policies
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(
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--团单唯一标识
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guid TEXT PRIMARY KEY,
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--团单号
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group_policy TEXT NOT NULL,
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--保险分公司名称
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insurer_company TEXT NOT NULL,
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--保险起期
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commencement_date TEXT NOT NULL,
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--保险止期
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termination_date TEXT NOT NULL
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)
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"""
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)
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# 初始化个单表
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self.execute(
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sql="""
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CREATE TABLE IF NOT EXISTS person_policies
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(
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--个单唯一标识
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guid TEXT PRIMARY KEY,
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--个单号
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person_policy TEXT NOT NULL,
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--保险起期
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commencement_date TEXT NOT NULL,
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--保险止期
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termination_date TEXT NOT NULL,
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--团单唯一标识，用于联查团案
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group_policy_guid TEXT NOT NULL
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)
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"""
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)
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# 初始化被保险人表，保司推送赔案时，一般无团单号，需先根据保险分公司名称、被保险人姓名、证件类型和证件号码查询被保人
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self.execute(
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sql="""
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CREATE TABLE IF NOT EXISTS insured_persons
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(
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--被保险人唯一标识
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guid TEXT PRIMARY KEY,
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--被保险人姓名
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insured_person TEXT NOT NULL,
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--证件类型
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identity_type TEXT NOT NULL,
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--证件号码
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identity_number TEXT NOT NULL,
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--与主被保险人关系，包括本人、父母、配偶和子女等
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relationship TEXT NOT NULL,
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--个单唯一标识，用于联查个单
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person_policy_guid TEXT NOT NULL
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)
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"""
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)
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# 初始化理赔责任表
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self.execute(
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sql="""
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CREATE TABLE IF NOT EXISTS liabilities
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(
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--理赔责任唯一标识
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guid TEXT PRIMARY KEY,
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--理赔责任名称
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liability TEXT NOT NULL,
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--出险事故
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accident TEXT NOT NULL,
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--个人自费理算比例
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personal_self_ratio TEXT NOT NULL,
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--个人自付理算比例
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non_medical_ratio TEXT NOT NULL,
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--合理理算比例
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reasonable_ratio TEXT NOT NULL,
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--理赔保单唯一标识
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claim_policy_guid TEXT NOT NULL,
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--个单唯一标识
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person_policy_guid TEXT NOT NULL
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)
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"""
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)
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# 初始化保额变动表
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self.execute(
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sql="""
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CREATE TABLE IF NOT EXISTS coverage_changes
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(
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--保额变动唯一标识
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guid TEXT PRIMARY KEY,
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--变动类型，包括承保和理算等
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change_type TEXT NOT NULL,
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--变动前金额
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before_change_amount TEXT NOT NULL,
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--变动金额
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change_amount TEXT NOT NULL,
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--变动后金额
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after_change_amount TEXT NOT NULL,
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--变动时间
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change_time TEXT NOT NULL,
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--变动保单唯一标识
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change_policy_guid TEXT NOT NULL
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)
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"""
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)
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# 初始化购药及就医机构表
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self.execute(
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sql="""
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CREATE TABLE IF NOT EXISTS institutions
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(
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--购药及就医机构
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institution TEXT PRIMARY KEY,
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--购药及就医机构类型
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institution_type TEXT NOT NULL,
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--所在省
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province TEXT NOT NULL,
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--所在市
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city TEXT NOT NULL
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)
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"""
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)
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# 初始化药品表
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self.execute(
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sql="""
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CREATE TABLE IF NOT EXISTS medicines
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(
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--药品/医疗服务
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medicine TEXT PRIMARY KEY
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)
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"""
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)
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except Exception as exception:
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raise RuntimeError(f"初始化主数据发生异常：{str(exception)}") from exception
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def query_liabilities(
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self,
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insurer_company: str,
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insured_person: str,
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identity_type: str,
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identity_number: str,
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report_date: str,
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) -> List[Dict[str, Any]]:
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"""
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根据保险分公司名称、被保险人姓名、证件类型、证件号码和报案时间查询被保险人的理赔责任
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:param insurer_company: 保险分公司名称
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:param insured_person: 被保险人姓名
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:param identity_type: 证件类型
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:param identity_number: 证件号码
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:param report_date: 报案时间
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:return: 被保险人的责任数据
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"""
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try:
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with self:
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result = self.query_all(
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sql="""
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SELECT group_policies.group_policy,
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group_policies.insurer_company,
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person_policies.person_policy,
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insured_persons.insured_person,
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insured_persons.identity_type,
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insured_persons.identity_number,
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insured_persons.relationship,
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master_insured_persons.insured_person AS master_insured_person,
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MAX(group_policies.commencement_date,
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person_policies.commencement_date) AS commencement_date,
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MIN(group_policies.termination_date,
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person_policies.termination_date) AS termination_date,
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liabilities.liability,
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liabilities.accident,
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liabilities.personal_self_ratio,
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liabilities.non_medical_ratio,
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liabilities.reasonable_ratio,
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liabilities.claim_policy_guid
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FROM insured_persons
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INNER JOIN person_policies
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ON insured_persons.person_policy_guid = person_policies.guid
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INNER JOIN insured_persons master_insured_persons
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ON person_policies.guid = master_insured_persons.person_policy_guid
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AND master_insured_persons.relationship = "本人"
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INNER JOIN group_policies
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ON person_policies.group_policy_guid = group_policies.guid
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INNER JOIN liabilities
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ON person_policies.guid = liabilities.person_policy_guid
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INNER JOIN coverage_changes
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ON liabilities.claim_policy_guid = coverage_changes.change_policy_guid
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AND coverage_changes.change_time = (SELECT MAX(change_time)
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FROM coverage_changes
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WHERE liabilities.claim_policy_guid = change_policy_guid)
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WHERE group_policies.insurer_company = ?
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AND insured_persons.insured_person = ?
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AND insured_persons.identity_type = ?
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AND insured_persons.identity_number = ?
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AND ? BETWEEN group_policies.commencement_date AND group_policies.termination_date
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AND ? BETWEEN person_policies.commencement_date AND person_policies.termination_date
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AND CAST(coverage_changes.after_change_amount AS REAL) > 0
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ORDER BY commencement_date
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""",
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parameters=(
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insurer_company,
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insured_person,
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identity_type,
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identity_number,
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report_date,
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report_date,
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),
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)
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if not result:
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raise RuntimeError("查无数据")
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# 就个人自费比例、个人自付比例和合理比例转为小数（decimal对象），保险起期、止期则转为日期时间（datetime对象）
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for index, record in enumerate(result):
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for key, value in record.items():
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match key:
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case _ if key in [
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"personal_self_ratio",
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"non_medical_ratio",
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"reasonable_ratio",
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]:
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result[index][key] = Decimal(value).quantize(
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Decimal("0.00"),
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rounding=ROUND_HALF_UP,
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)
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case _ if key in ["commencement_date", "termination_date"]:
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result[index][key] = datetime.strptime(value, "%Y-%m-%d")
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return result
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except Exception as exception:
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raise RuntimeError(f"{str(exception)}") from exception
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def query_institution_type(self, institution: str) -> str:
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"""
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根据购药及就医机构名称查询购药及就医机构类型
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:param institution: 购药及就医机构名称
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:return: 购药及就医机构类型
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"""
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try:
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with self:
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result = self.query_one(
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sql="""
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SELECT institution_type
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FROM institutions
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WHERE institution = ?
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""",
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parameters=(institution,),
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)
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if not result:
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raise RuntimeError("查无数据")
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return result["institution_type"]
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except Exception as exception:
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raise RuntimeError(f"{str(exception)}") from exception
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def query_medicine(
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self,
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content: str,
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) -> str:
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"""
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根据明细项中具体内容查询药品/医疗服务名称
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:param content: 明细项具体内容
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:return: 药品/医疗服务名称
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"""
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try:
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with self:
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result = self.query_all(
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sql="""
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SELECT medicine
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FROM medicines
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WHERE ? LIKE '%' || medicine || '%'
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""",
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parameters=(content,),
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)
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if not result:
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raise RuntimeError("查无数据")
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return max(result, key=lambda x: len(x["medicine"]))[
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"medicine"
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] # 返回最大长度的药品/医疗服务
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except Exception as exception:
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raise RuntimeError(f"{str(exception)}") from exception
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def query_remaining_amount(
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self,
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policy_guid: str,
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) -> Decimal:
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"""
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根据变动保单唯一标识查询最新一条保额变动记录的变动后金额
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:param policy_guid: 变动保单唯一标识
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:return: 变动后金额
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"""
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try:
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with self:
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result = self.query_one(
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sql="""
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SELECT after_change_amount
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FROM coverage_changes
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WHERE change_policy_guid = ?
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ORDER BY change_time DESC
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LIMIT 1;
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""",
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parameters=(policy_guid,),
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)
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if not result:
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raise RuntimeError("查无数据")
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return Decimal(result["after_change_amount"]).quantize(
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Decimal("0.00"),
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rounding=ROUND_HALF_UP,
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)
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except Exception as exception:
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raise RuntimeError(f"{str(exception)}") from exception
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