城乡居民基本医疗保险基金平衡的随机模拟研究

发布时间：2018-02-24 05:32

本文关键词： 城乡居民基本医疗保险医保基金随机模拟　出处：《中国卫生经济》2016年12期 　论文类型：期刊论文

【摘要】：目的:探讨城乡居民基本医疗保险基金平衡的测算方法,为医保管理部门和研究者提供科学参考。方法:通过现场调查获得参保人群的就医参数,采用蒙特卡罗随机模拟的方法,模拟测算在不同补偿方案下基金的平衡情况。结果:参保人群的年住院率为8.76%,县内住院比例为40%,实际补偿率为52%;将乡镇卫生院、县级医院、市级医院和市外医院住院的实际补偿比分别提高到82%、75%、56%和51%时,基金使用率分别为91%、95%、99%和96%。结论:同等比例提高县级医院和市级医院的补偿比时,基金的使用率的提高相对较快,建议补偿政策继续向基层医疗机构倾斜;随机模拟技术可以为医保基金的平衡测算提供新方法。
[Abstract]:Objective: to study the method of measuring the balance of basic medical insurance fund for urban and rural residents, and to provide a scientific reference for medical insurance management departments and researchers. Monte Carlo random simulation method was used to simulate and calculate the fund balance under different compensation schemes. Results: the annual hospitalization rate of insured population was 8.76, the proportion of county residents was 40 and the actual compensation rate was 52. When the actual compensation ratio of municipal hospitals and outside hospitals increases to 827575 / 56% and 51% respectively, the utilization rate of funds is 91 / 95 / 99% and 96 / 96 respectively. Conclusion: when the compensation ratio of county-level hospitals and municipal hospitals is increased in the same proportion, the utilization rate of funds increases relatively quickly. It is suggested that the compensation policy should continue to favor the primary medical institutions, and the stochastic simulation technology can provide a new method for the balance calculation of the health insurance fund.
【作者单位】：浙江省医院发展中心改革研究科;温州医科大学公共卫生与管理学院卫生管理系;
【基金】：浙江省自然科学基金项目(LQ15G030011) 浙江省哲学社会科学重点研究基地(省劳动保障与社会政策研究中心)课题项目(14JDLB03YB)
【分类号】：R197.1;F842.684

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