新型农村合作医疗基金预警系统模型的建立研究  

Study on Establishment of Early Warning Model of the New Rural Cooperative Medical Insurance Fund

作　　者：高广颖[1] 梁民琳 沈文生 马千惠[1] 陈月娟 

机构地区：[1]首都医科大学卫生管理与教育学院,北京100069 [2]黑龙江省卫生和计划生育委员会,哈尔滨150090 [3]吉林省卫生和计划生育委员会,长春130021

出　　处：《中国卫生经济》2015年第2期56-59,共4页Chinese Health Economics

基　　金：教育部人文社科一般项目(10YJA630034)

摘　　要：目的:为了控制新农合医保基金风险,保障基金安全,根据住院补偿金使用情况建立基金预警系统,防止基金超支现象的发生。方法:以黑龙江、吉林两省数据为例,运用统计学分析方法对住院补偿金的使用情况进行模型拟合,并划定预警区间,根据基金风险程度,按照红、黄、蓝三个预警等级进行分级预警。结果:得到黑、吉两省住院补偿金占比情况与月份之间的拟合模型,同时得到关于该模型的95%个体预测区间。结论:基金管理部门应该建立相应的预警机制,采取预警区间分级预警的方法,降低医疗保障基金运行风险。Objective:In order to control the risk and to guarantee the safety of the new rural cooperative medical insurance fund,an early warning system was established based on the use of hospitalization compensation, which could prevent the fund cost overruns.Methods: The data from Heilongjiang and Jilin was used as the example. With the statistical analysis methods, it tried to fit the use ofhospitalization compensation with a model,g intervals and classified early warning by different warninggrades(red, yellow and blue) and risk levels.R edseulilmtsi:ted the warninThe fitted model of hospitalization compensation proportions and the months wascollected, and its 95% individual prediction intervals were calculated.Conclusion:Fund management department should establish cor-responding early warning system and adopt the pre-warning classification method to reduce the risk of medical insurance fund operation.

关 键 词：新型农村合作医疗 基金风险 预警系统 

分 类 号：F842.684[经济管理—保险] R197.1[医药卫生—卫生事业管理]