城镇居民基本医疗保险报销比例蒙特卡洛模拟测评

发布时间：2018-05-08 03:04

本文选题：蒙特卡洛模拟 + 城镇居民基本医疗保险　；参考：《中国卫生经济》2013年02期

【摘要】：目的:探讨不同医疗保险报销比例对心肌梗死住院病人直接经济负担的影响。方法:根据天津市城镇居民基本医疗保险数据库2007年316例心肌梗死病人数据资料,运用蒙特卡洛模拟仿真技术,模拟当前天津市城镇居民基本医疗保险补偿模式,并对不同医院级别报销比例进行模拟探讨。结果:(1)报销比例依次提高10%,一、二、三级医院住院费用人均收入比分别下降1.3%、2%和5%,住院费用相当的劳动时间分别减少0.15个月、0.23个月、5个月;(2)在报销比例为75%时,三级医院个人住院直接经济负担有明显下降趋势;(3)当各级医院报销比例下降或上升5%时,心肌梗死病人人均住院费增加或减少约700元,住院费人均收入比增加或减少2%,会减轻天津市心肌梗死病人总经济负担约3.75亿元。结论:报销比例的变化对三级医院住院患者直接经济负担影响较大,运用蒙特卡洛随机模拟仿真技术能有效的模拟城镇居民基本医疗保险补偿模式,为我国卫生保险政策的制定提供了指导和参考。
[Abstract]:Objective: to investigate the effect of different proportion of medical insurance reimbursement on direct economic burden of inpatients with myocardial infarction. Methods: according to the data of 316 patients with myocardial infarction in Tianjin urban residents' basic medical insurance database in 2007, Monte Carlo simulation technology was used to simulate the current basic medical insurance compensation model for urban residents in Tianjin. At the same time, the proportion of reimbursement in different hospital levels was simulated and discussed. Results the proportion of reimbursement increased by 10% in turn. First, second, the per capita income ratio of hospital expenses in tertiary hospitals decreased by 1.3% and 5%, respectively, and the labor time of the same hospitalization expenses decreased by 0.15 months to 0.23 months, and in 5 months to 2 months) when the reimbursement ratio was 75. There is a significant downward trend in the direct economic burden of individual hospitalization in tertiary hospitals. When the reimbursement ratio of hospitals at all levels decreases or rises by 5 percent, the average hospitalization fee for patients with myocardial infarction increases or decreases by about 700 yuan. The increase or decrease of the per capita income ratio of hospitalization expenses will alleviate the total economic burden of patients with myocardial infarction in Tianjin by about 375 million yuan. Conclusion: the change of reimbursement ratio has a great influence on the direct economic burden of inpatients in tertiary hospitals. Monte Carlo random simulation technology can effectively simulate the basic medical insurance compensation model of urban residents. It provides guidance and reference for the formulation of health insurance policy in China.
【作者单位】：天津医科大学公共卫生学院;
【分类号】：F842.6

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