| 引用本文: |
齐新业,吴群红,康正,等.基于ProModel仿真的黑龙江省基本医疗保险收支平衡政策干预模拟研究[J].中国卫生经济,2018,(2):35-38.[点击复制] |
.Study on Medical Insurance Fund Revenue and Expenditure Prediction Based on ProModel Simulation:Take Heilongjiang Province as an example[J].CHINESE HEALTH ECONOMICS,2018,(2):35-38.[点击复制] |
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| 摘要: |
| 目的：应用ProModel仿真软件模拟黑龙江省基本医疗保险基金运行情况，研究不同干预政策下医保基金收支平衡效果。方法：构建基本医疗保险体系ProModel仿真模型，基于黑龙江省医保历史相关数据对黑龙江省基本医疗保险未来运行情况进行仿真实验干预模拟。结果：干预模拟实验显示，保持基本变量增长率的前提下提高筹资标准，医保基金结余相应增加；提高筹资标准，改变就诊流向，医保基金变动更为缓和；提高筹资标准，适当调整补偿水平，医保基金结余有所变动；筹资标准、就诊流向、补偿水平同时调整下，医保基金结余较之前更为合理。结论：提高不同医疗保险的筹资水平，初步实施分级诊疗（降低三级医院就诊比，提高一、二级医院就诊比）会在确保基本医疗保险收支平衡的同时，提高三大医疗保险基金结余率，即适当提高医保筹资水平，实施分级诊疗可在保证医保基金结余的同时进一步提升医保补偿水平。 |
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| Study on Medical Insurance Fund Revenue and Expenditure Prediction Based on ProModel Simulation:Take Heilongjiang Province as an example |
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| Abstract: |
| Objective : Simulating the Operation of Basic Medical Insurance Fund in Heilongjiang Province and studying the balance of income and expenditure of health insurance fund under different intervention policies by Applying the ProModel Simulation Software. Methods: Using ProModel simulation software construct the basic medical insurance system simulation model. Based on the historical data of Heilongjiang Province medical insurance in Heilongjiang Province, The simulation experiment of the basic medical insurance in Heilongjiang Province is simulated. Results: Intervention simulation experiments show that maintaining the basic variable growth rate, raising the funding standard, the health care fund balance increased;Raise funding standards, change the flow of treatment, health care fund changes more moderate; Improve the financing standards and appropriate adjustment of the level of compensation, health care fund balance has changed; A djust Financing standards, treatment flow and the level of compensation at the same time, the health care fund balance is more reasonable than before. Conclusion : Improve the level of financing of different medical insurance, the initial implementation of the classification of medical treatment will ensure the balance of basic medical insurance and improve the balance of the three health insurance fund |
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