深圳市医疗费用预测分析及医疗保险基金管理对策研究

Prediction Analysis of Medical Expenses and Study on the Management Countermeasures of Medical Insurance Fund in Shenzhen City

目的以深圳市医疗费用预测模型为例，为控制医疗费用过度增长，促进医疗保险基金稳定运行提供依据。方法利用SPSS18．0和Excel2003软件建立ARIMA模型和线性回归模型，分析深圳市2011年7月～2013年6月各项医疗费用的变化趋势。结果至2012年10月，深圳市总医疗费用将超过缴费金额，医疗保险基金将面临风险，其中门诊基金、门诊药费和门诊诊疗费的月均增长率分别为1．94％、2．34％和2．27％，门诊费用尤其是门诊药费的快速增k，可能是导致医疗保险基金失衡的最主要原因；住院基金、住院药费和住院诊疗费的月均增长率分州为1．62％、1.25%和1．55％，尚不存在医疗保险基金风险。结论ARIMA模型对于医疗费用的动态分析及预测不大为一种适用方法；针对门诊费用快速增长引起的医疗保险基金失衡问题，建议相关部门加强医疗保险基金峨管力发，建立基金预警平台系统，保证基金安全健康运行。

Objectives To take medical expenses prediction model in Shenzhen for example, and to provide a basis for controlling the excessive growth of medical expenses and promote the stable operation of the medical insurance fund. Methods Establishing ARIMA model and linear regression model with SPSS 18.0 and Excel 2003, analyzing the trend of total medical expenses from July 2011 to June 2013 in Shenzhen. Results To October 2012, the total medical expenses in Shenzhen would exceed the payment amount, the medical insurance fund would be at risk, the average monthly growth rates of the outpatient fund, outpatient drug costs and outpatient medical treatment fees were 1.94%,2.34% and 2.27% respectively, the rapid growth of the outpatient costs （especially the drug costs） may be the main reason of the fund imbalance. The average monthly growth rates of the inpatient fund, inpatient drug costs and inpatient medical treatment fees were 1.62%, 1. 25% and 1. 55% respectively, the fund risk had not existed yet. Conclusions ARIMA model may be a suitable method for dynamic analysis and forecast of medical ex- penses. About the imbalance of medical insurance fund caused by the rapid growth of outpatient costs, it is recom- mended for relevant departments to strengthen the supervision of the medical insurance fund, and to establish the early warning system of the fund to ensure that the fund runs safely and healthy.