社会医疗保险背景下住院者过度索赔影响因素分析

Influence factors of excessive claims by inpatients under the circumstances of social medical insurance

目的:探讨在社会医疗保险背景下住院者过度索赔的影响因素,提高医疗保险欺诈的识别概率。方法:通过检验和Logistic回归模型找出影响住院者过度索赔的因素。结果:住院者过度索赔的影响因素:住院费用、住院期间保健品的购买、报销费用时熟人的关照。结论:利用Logistic回归模型判断和预测医疗保险过度索赔发生的可能性大小,为欺诈行为的识别提供参考依据。

Objective To investigate the factors affecting excessive claims by inpatients under the circumstances of social medical insurance,to improve the recognition probability of medical insurance fraud. Methods The influence fac tors of excessive claims were found by Chi-- square test and Logistic regression model. Results The influence factors were hospitalization expenses,the purchase of health care products during hospitalization,and acquaintances＇ favor dur- ing reimbursement. Conclusions Logistic regression models are used to judge and predict the likelihood of excessive claims for medical insurance,which can provide reference for identifying fraud.