城市居民医疗保险费用模拟分析

Simulation analysis of medical insurance cost for urban residents in Kunming,China

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险政策时,考虑医疗保险政策的可持续发展。

Objective To predict the medical expenses and distribution of different medical payments of urban residents in Kunming,who are covered by the medical insurance scheme.Methods We created a static micro-simulation model for predicting and evaluating the 2008-2010 medical insurance scheme for urban residents of Kunming.The main datasets used for constructing the model included： a 0.1% population sample dataset from the national census of 2000 and a dataset of urban employees and retirees under the social medical insurance scheme.Other data used in the model involved the aggregated results of 1% population survey of Kunming conducted in 2005.Results Based on the population model of 2005,the population information and the data of employees and retirees covered by the social medical insurance scheme were integrated.The model provided information on resident incomes,medical expenses,medical expenses of outpatient services and severe illness;and the different kinds of payments could be forecasted by the model.Conclusion Results of the present research can help the government in making relevant heath policies while ensuring the sustainable development of medical insurance scheme.