城镇居民基本医疗保险报销比例蒙特卡洛模拟测评

Monte Carlo Simulation of the Urban Resident Basic Medical Insurance Reimbursement Ratio

目的:探讨不同医疗保险报销比例对心肌梗死住院病人直接经济负担的影响。方法:根据天津市城镇居民基本医疗保险数据库2007年316例心肌梗死病人数据资料,运用蒙特卡洛模拟仿真技术,模拟当前天津市城镇居民基本医疗保险补偿模式,并对不同医院级别报销比例进行模拟探讨。结果:(1)报销比例依次提高10%,一、二、三级医院住院费用人均收入比分别下降1.3%、2%和5%,住院费用相当的劳动时间分别减少0.15个月、0.23个月、5个月;(2)在报销比例为75%时,三级医院个人住院直接经济负担有明显下降趋势;(3)当各级医院报销比例下降或上升5%时,心肌梗死病人人均住院费增加或减少约700元,住院费人均收入比增加或减少2%,会减轻天津市心肌梗死病人总经济负担约3.75亿元。结论:报销比例的变化对三级医院住院患者直接经济负担影响较大,运用蒙特卡洛随机模拟仿真技术能有效的模拟城镇居民基本医疗保险补偿模式,为我国卫生保险政策的制定提供了指导和参考。

Objective： To explore the direct economic burden of myocardial infarction patients in the different medical insurance reimbursement ratio policies. Methods： According to the information of 316 cases of myocardial infarction patients in the Tianjin urban residents＇ basic medical insurance database in 2007, utilizing the Monte Carlo simulation technique, and simulating the current urban resident basic medical insurance compensational mode in Tianjin and the different levels of hospital reimbursement ratio are discussed. Results： First of all, with the reimbursement ratio increased by 10% in turn, the ratio of hospital cost divided by the average per capita income in each hospital decreased 1.3%, 2% and 5% respectively and the hospital cost comparative labor time reduced 0.15, 0.23 and 5 months. Secondly, In proportion to submit an reimbursement ratio accounting for 75%, the personal hospitalization direct economic： burden has obvious downtrend in the tertiary hospital. Finally, with all levels of the hospital reimbursement ratio increasing by 5%, the per capita hospitalization expenses of myocardial infarction patients reduces approximately 700 yuan, and the ratio of hospital cost divided by the average per capita income fells by 2% , which can reduce total economic burden of the Tianjin myocardial infarction patients about 375 million yuan. Conclusion： The change of reimbursement ratio in the tertiary hospital influences on the patients＇ direct economic burden significantly; Using the Monte Carlo random simulation technology can simulates urban resident basic medical insurance compensation mode effectively; It is much significant to plan the health insurance policy and lays the ground for future studies.