损失分布在合作医疗补偿方案制定中的应用

APPLICATION OF LOSS DISTRIBUTION IN MAKING SUBSIDY PROJECT OF THE CMS

[目的]全面分析合作医疗补偿方案的确定,重点研究补偿比例的测算。[方法]将损失分布引入分解推算法中测算补偿比例。[结果]①一、二、三级医疗机构住院补偿起付线可分别定为400元、500元、800元,封顶线为50 000元;②住院费用和特殊病种门诊费用均服从于BURR分布;③若筹资标准不变,二、三级医疗机构的补偿比例应分别下调5个和10个百分点。[结论]农民的受益面偏窄;费用补偿的起付线和封顶线应设置适当;应用损失分布法测算补偿比例精确性比较好。

[Objectives]To study on making subsidy project of the CMS（Cooperative Medical System）.[Methods]Loss distribution was introduced to decompose extrapolation model to determine subsidy proportion.[Results]①The compensatory low limit of hospitalization expenses could be $400,$500 and $800 in grade 1,grade 2 and grade 3 hospitals respectively,and the maximum could be $50 000.②The BURR distribution was proper to fit to the distribution models of hospitalization expenses,as well as medical expenses of special diseases in clinic service;③If fund-raising standard didn＇t change,5 percentage point and 10 percentage point should be descended in subsidy proportion in grade 2 and grade 3 hospitals respectively.[Conclusions]The benefit coverage gained by peasants is narrow.The low limit and maximum of hospitalization expenses should be set properly.The accuracy can be improved when loss distribution is applied in making subsidy proportion.