城镇职工基本医疗保险门诊费用补偿政策研究

The Study on Compensation Policy for Basic Medical Insurance of Outpatient Payment of Urban Employees

从拟合XA市不同级别医疗机构门诊费用的分布入手,依据不同的费用补偿方式,利用损失分布模型构建了不同补偿方式下城镇职工基本医疗保险门诊费用补偿额的预测模型。在构建上述模型的基础上,分别针对不同门诊费用补偿方式构建了XA市城镇职工基本医疗保险门诊费用补偿的政策模型。最后,根据分析结果,提出了相关的政策建议。

The paper firstly fits the distribution of the outpatient fees in medical institutions of different levels in XA city, and based on the different ways of reimbursement, uses loss distribution model to construct the prediction models of the outpatient fees compensation in the basic medical insurance for urban workers. Based on the construction of the models above, the paper constructs the policy models of the outpatient fees compensation in the basic medical insurance for urban workers according to the different ways of reimbursement. Finally, according to the results of the analysis, some related policy recommendations are proposed.