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重尾是医疗费用以及医疗保险损失分布的常见特征之一,本文构建了在重尾分布下,医疗保险经营者科学评估医疗保险保费合理性的模型和方法。当医疗费用面临二阶矩不存在的重尾性下,稳定分布理论中的广义中心极限定理可以取代古典的中心极限定理去评估医疗保险保费的合理性。本文最后用2008年上海市闵行区新型农村合作医疗的住院医疗费用数据进行了实证分析,全面探测了医疗费用的重尾性以及在尾部指标的基础上,估计了闵行区新农合筹资的合理性.
The heavy tail is one of the common features of medical expenses and the distribution of medical insurance losses. This paper constructs a model and method for medical insurance managers to rationally evaluate the premium of medical insurance under the heavy tail distribution. When medical costs are faced with heavy tail with non-existence of second moment, the generalized central limit theorem in stable distribution theory can replace the classical central limit theorem to evaluate the rationality of medical insurance premiums. In the end, this paper empirically analyzes the hospitalization cost data of the new rural cooperative medical system in Shanghai Minhang District in 2008, and probes into the heavy tail of the medical expenses comprehensively and estimates the reasonableness of financing for the NCMS in Minhang District based on the tail index Sex.