新疆某县新农合基金风险预警模型的构建研究

发布时间：2018-06-15 22:02

本文选题：新型农村合作医疗制度 + 基金风险　；参考：《新疆医科大学》2017年硕士论文

【摘要】：目的:通过对新疆某县新农合运行状况的分析,对该县新农合基金风险进行识别、建立新农合基金风险管理指标体系、构建基金风险预警模型及基金风险预警体系。方法:收集新疆某县2009～2015年新农合报表及统计年鉴相关数据,结合关键知情人访谈分析该县新农合制度运行状况及存在问题;通过三轮德尔菲专家咨询建立新农合基金风险管理指标体系,基于该县新农合历年数据利用MIV算法筛选变量并建立灰色GM(1,n)预测模型。结果:(1)新疆某县新农合覆盖面不断扩大,2015年参合率达1000%;筹资标准由2009年的120元/人.年提高到2015年的520元/人·年;2015年门诊和住院补偿人次分别为104563人次和7523人次,实际补偿比分别为76.12%和51.78%;累计基金结余支付能力由2009年的0.53年减少到2015年的-0.04年。(2)德尔菲专家咨询共咨询专家19人,专家的权威程度为0.8,专家对指标重要性、风险发生可能性和风险危害程度三个维度意见的协调系数均为0.3,经一致性检验(x_(指标重要程度)~2=27.65;x_(风险发生可能性)~2=26.33;x_(风险危害程度)~2=26.54,p0.05)有意义。建立起包括环境风险、制度风险、基金筹集风险、基金支付风险和管理风险5个一级指标和30个二级指标的新农合基金风险管理指标体系。对指标均值进行综合排序,排名前三位的一级指标是基金支付风险、制度风险和管理风险,二级指标为县外住院比例、县外住院补偿金额占住院补偿总额比例和次均住院费用。(3)利用MIV算法筛选出地区慢性病患病率、目录内药品报销比例、参合人员住院率和次均住院费用4个变量并建立起关于新农合基金结余支付能力的灰色GM(1,n)预测模型,模型精度为92.44%。结论:新疆某县新农合基金风险主要来自基金筹集和支付环节;德尔菲专家咨询结果可靠,建立的新农合基金风险管理指标体系完善.且符合实际;通过筛选关键变量建立的新农合基金风险预警模型合格能用来预测。
[Abstract]:Objective: to identify the risk of the new rural cooperative fund in a county of Xinjiang, to establish the risk management index system of the new rural cooperative fund, and to construct the early-warning model of the fund risk and the early-warning system of the fund risk. Methods: to collect the relevant data of the NCMS report form from 2009 to 2015 and the statistical yearbook in a certain county of Xinjiang, and analyze the operating status and existing problems of the NCMS system in the county with interviews with key insiders. The risk management index system of NCMS is established through three rounds of Delphi expert consultation. Based on the data of NCMS over the years, the variables are screened by MIV algorithm and the grey GMGM1n) prediction model is established. Results (1) the coverage of NCMS in a certain county of Xinjiang was continuously expanded, and the participation rate reached 1000 yuan in 2015, and the funding standard was 120 yuan per person in 2009. In 2015, the number of outpatient and in-patient compensations was 104563 and 7523, respectively. The actual compensation ratio is 76.12% and 51.78%, respectively; the cumulative capacity to pay fund balances has decreased from 0.53 years in 2009 to -0.04% in 2015.) the Delphi expert consultation has 19 consultants, with a degree of authority of 0.8.The experts are important to the indicators. The coordination coefficient of the three dimensions of risk occurrence possibility and risk hazard degree is 0.3, which is meaningful after consistency test. A new index system of NCMS risk management including environmental risk, institutional risk, fund raising risk, fund payment risk and management risk is established. According to the comprehensive ranking of the average index, the top three first-level indicators are fund payment risk, institutional risk and management risk, and the second level index is the proportion of hospitalization outside the county. Using MIV algorithm to screen the prevalence rate of chronic diseases and the proportion of drug reimbursement in the catalogue. The four variables of hospitalization rate and average hospitalization cost of the participants and the grey GM1N) prediction model about the balance and payment ability of the new rural cooperative fund are established. The precision of the model is 92.4444. Conclusion: the risk of NCMS in a county of Xinjiang mainly comes from fund raising and payment, the expert consultation result of Delphi is reliable, and the risk management index system of NRCF is perfect. The risk early warning model established by screening key variables can be used to predict the risk.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F842.684;F323.89

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