深圳市2010年度医疗保险费用分析

发布时间：2018-03-15 22:19

本文选题：深圳市　切入点：住院医疗费用　出处：《华中科技大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的从一般特征和住院费用等方面，比较深圳市三种医疗保险类型的差异。探讨影响参保患者住院费用的因素，对医疗保险基金住院支出金额进行准确预测。为控制医疗费用，保障基金收支平衡，完善医保制度建设和医药卫生体制改革提供参考。方法本研究以深圳市2010年7月—2011年6月，综合医疗保险、住院医疗保险和农民工医疗保险三种医疗保险的参保人为研究对象，共纳入参保人244096人。应用描述性分析、卡方检验和非参数检验的方法，比较不同参保类型的差异；应用广义线性回归模型分析医疗保险患者住院费用的影响因素。应用时间序列模型ARIMA，对2003到2010年度住院医疗统筹基金支出进行拟合和预测。采用Excel、SPSS l3.0统计软件进行统计分析。结果 1.三种参保类型比较: 三种参保类型的性别、户籍类型、职工类别、年龄构成情况的差异有统计学意义。农民工医疗保险特点突出，参保人为非深圳户籍劳务工人员，男性比例大，年龄结构偏轻。住院总费用、药费、诊疗费、报销比例等在三种参保类型间的差异有统计学意义。农民工医疗保险整体处于偏低水平。 2.住院总费用的影响因素：对住院总费用影响因素分析显示，性别、户籍类型、职工类别、年龄、参保类型、住院次数、报销比例均为影响住院总费用的因素（P0.001）。 3.住院医疗统筹基金支出预测对住院医疗统筹基金支出进行预测，得到ARIMA(0，1，1)(0，1，0)12模型，平均相对误差为3.00%，显示预测值对住院统筹基金支出有很好的预测效果。结论深圳市三种医疗保险各有特色，农民工医疗保险筹资和保障水平低，，综合医疗保险人群的年龄和职工类别较均衡。住院医疗费用受住院次数、报销比例等因素影响。应用ARIMA模型对住院医疗统筹基金支出预测，显示了很好的预测效果，可用于基金预测。
[Abstract]:Objective to compare the differences among the three types of medical insurance in Shenzhen from the aspects of general characteristics and hospitalization expenses. To explore the factors affecting the hospitalization expenses of insured patients, and to predict accurately the amount of hospitalization expenses of the medical insurance fund in order to control the medical expenses. To ensure the balance of income and expenditure of the fund, to improve the construction of the medical insurance system and the reform of the medical and health system. Methods this study is based on the comprehensive medical insurance in Shenzhen from July 2010 to June 2011. The participants of three kinds of medical insurance including hospitalization medical insurance and migrant workers' medical insurance were taken as the research object, which included 244096 insured persons. Using descriptive analysis, chi-square test and non-parametric test, the differences of different insured types were compared. The influencing factors of hospitalization expenses of medical insurance patients were analyzed by using generalized linear regression model, and the expenditure of hospital medical plan fund was fitted and predicted by time series model Arima. The statistical software of Excel SPSS l 3.0 was used to carry out statistical analysis. Results. 1. Comparison of three types of insurance:. The differences of sex, household registration type, employee category and age composition of the three types of insurance are statistically significant. The characteristics of migrant workers' medical insurance are prominent, and the insured persons are non-Shenzhen household registered workers, with a large proportion of men. The difference of total hospitalization expenses, medical expenses, medical expenses, reimbursement ratio among the three types of insurance is statistically significant. The overall level of medical insurance for migrant workers is on the low side. 2. Factors affecting total hospitalization costs:. The analysis of the factors influencing the total cost of hospitalization showed that gender, household registration type, employee type, age, type of insurance, times of hospitalization and reimbursement ratio were all the factors affecting the total cost of hospitalization (P 0.001). 3. Expenditure forecast of the inpatient health care coordination fund. The ARIMA model was obtained, and the average relative error was 3.00, which showed that the predicted value had a good effect on the inpatient fund expenditure. Conclusion the three kinds of medical insurance in Shenzhen have their own characteristics, the level of financing and security of medical insurance for migrant workers is low, the age and the type of workers are more balanced, and the hospitalization costs are more frequent. The application of ARIMA model to the forecast of inpatient medical fund expenditure shows a good effect and can be used to forecast the fund.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R197.1;F842.684

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