城镇居民基本医疗保险门诊统筹补偿比例测算

Estimation on the Compensation Proportion of the Outpatient Coordination in Urban Resident Basic Medical Insurance

为了简化和方便门诊统筹费用的测算,根据甘肃省样本地区城镇居民2011—2012年门诊医疗费用数据,利用1stOpt软件拟合出了门诊医疗费用损失分布模型,构建了城镇居民门诊统筹基金短期平衡模型。测算结果表明,甘肃省城镇居民门诊费用服从对数正态分布,鉴于目前甘肃省筹资水平较低,增长幅度较慢,但门诊费用增长过快的现实,在测算起付线、封顶线和支付比例时,从低水平起步,今后视基金节余情况逐年提高补偿标准。

In order to simplify the estimation of outpatient coordination costs, based on the data of 2011-2012 urban resident outpatient medical costs in the sample areas of Gansu, the Software of lstOpt was used to match the loss distribution model of outpatient medical costs, short-term balance model of urban resident outpatient coordination financing funds was built. The result of estimation showed, Gansu urban resident outpatient medical costs obeyed lognormal distribution. Since the financing level in Gansu was lower, the increasing growth was slow, but the outpatient cost growed too fast. While estimating pay line, cap line and payment proportion, it should start from a low level and increase gradually as the fund surplus situation in the future.