| 摘要: |
| 目的针对城镇居民医疗保险体系,预测参保居民的医疗费用和各方费用分担分布。方法通过构建微观模拟模型,预测和评估2008~2010年昆明市城镇居民医疗保险政策。构建模型的数据包括2000年国家人口普查的0.1%样本数据,城镇职工医疗保险体系下的参保数据,其他数据信息包括昆明市2005年国家1%人口调查的结果。结果在2005年人口模型的基础上,实现人口信息数据和参保职工信息数据的统计拼接。获得个体收入和医疗消费信息,居民门诊大病和住院医疗的费用分布,预测不同途径的缴费水平。结论分析结果有助于政府在制订相关医疗保 |
| 关键词: 城镇居民 医疗保险 医疗费用 |
| DOI：10.3724/SP.J.1008.2011.0741 |
| 投稿时间：2011-03-04修订日期：2011-05-22 |
| 基金项目:澳大利亚堪培拉大学博士奖学金资助项目 |
|
| Simulation analysis of medical insurance cost for urban residents in Kunming, China |
| XIONG Lin-ping1*,XIA Deng-wen2,DING Tao3 |
| (1. Department of Health Service Management, Faculty of Health Services, Second Military Medical University, Shanghai 200433, China;2. Department of Medical and Maternity Insurance, Bureau of Labour and Social Security of Kunming, Kunming 650011, Yunnan, China;3. Department of Health Services, Faculty of Health Services, Second Military Medical University, Shanghai 200433, China) |
| Abstract: |
| Objective To predict the medical expenses and distribution of different payment for urban residents who entering the medical insurance scheme. Methods The article created a static micro simulation model for predicting and evaluating the medical insurance scheme in urban areas for the period of 2008-2010. The main datasets used in constructing the model include: a 0.1 per cent population sample dataset from the 2000 Census for all individuals; and a dataset of employees and retirees under the social medical insurance scheme. The other information used in the model involves the aggregated results of the 1 per cent population survey of Kunming conducted in 2005. Results Based on the population model 2005-2010, the updated Census dataset was statistically matched with the individual dataset of insured employees and retirees. The model provided information on incomes, hospital services usage and medical expenses. Medical expenses of general hospital services as well as serious illness clinic services were provided and the different kinds of payments could be forecasted. Conclusion The results from this research are essential in making the challenging policy decisions when considering the long-term financial sustainability of the medical insurance scheme. |
| Key words: urban residents medical insurance medical expenses |
