社会医疗保险的医疗费用函数建模分析

Modeling and Analyzing on Health Care Expenditure Function in Social Medical Insurance

由于疾病发生的随机性、医学技术进步和道德风险的影响,社会医疗保险在医疗费用的精算上存在着很大困难。以我国社会医疗保险患者中336万余次实际就诊记录的大样本数据资料为基础,通过显著性因子检验,建立了以工资收入、相对医疗费用指数、职工类别和性别为参数的医疗费用函数多元回归对数线性模型,并成功地应用于社会医疗保险基金运行过程的仿真分析之中,对于社会医疗保险的管理与决策具有重要的价值。

Affected by random occurrence of diseases,rapid progresses in medical technology and moral hazards,the health care expenditure on social medical insurance become difficult in actuarial estimation. The authors give an F test on sample data from 3.36million real cases in china social medical insurance,and present a logarthmically linear regression model with multi variables,such as age,income,relative index of expenditure,insurant category and gender to describe the health care expenditure function. This model has been successfully applied to computer simulation and quantitative analysis on the operation process of social medical insurance fund and is valuable for management and decision making support.