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目的:探讨城乡居民基本医疗保险基金平衡的测算方法,为医保管理部门和研究者提供科学参考。方法:通过现场调查获得参保人群的就医参数,采用蒙特卡罗随机模拟的方法,模拟测算在不同补偿方案下基金的平衡情况。结果:参保人群的年住院率为8.76%,县内住院比例为40%,实际补偿率为52%;将乡镇卫生院、县级医院、市级医院和市外医院住院的实际补偿比分别提高到82%、75%、56%和51%时,基金使用率分别为91%、95%、99%和96%。结论:同等比例提高县级医院和市级医院的补偿比时,基金的使用率的提高相对较快,建议补偿政策继续向基层医疗机构倾斜;随机模拟技术可以为医保基金的平衡测算提供新方法。
Objective: To explore the method of calculating the balance of basic medical insurance for urban and rural residents and to provide a scientific reference for medical insurance management departments and researchers. Methods: The medical parameters of insured population were obtained through on-the-spot investigation, and the stochastic simulation of Monte Carlo method was used to simulate the balance of funds under different compensation schemes. Results: The annual hospitalization rate of the insured population was 8.76%, the hospitalization rate in the county was 40%, and the actual compensation rate was 52%. The actual compensation rates of the hospitalization of township hospitals, county hospitals, municipal hospitals and municipal hospitals At 82%, 75%, 56% and 51%, fund utilization rates were 91%, 95%, 99% and 96% respectively. Conclusions: When the same ratio is used to improve the compensation rate of county-level hospitals and municipal-level hospitals, the utilization rate of the funds is relatively fast, suggesting that the compensation policy should continue to be inclined to the primary medical institutions. Stochastic simulation can provide a new method for the balance measurement of the medical insurance funds .