运用聚类分析方法确定医疗保险费用结算标准

Using Cluster Analysis to Ascertain the Settlement Criterions of Medical Insurance Expenditure

运用聚类分析方法将具有相似费用、规模和实效的医院归并合类,确定同类医院的医疗保险费用结算标准。结果46家三级医院按其次均医疗费用、住院病人数和床天费用聚成7类,各类之间的分类指标具有统计学差异。文章分析了不同类别医院的特征,认为运用聚类分析方法确定同类医院的定额结算标准,一方面既考虑了不同医院的规模和服务对象与病种的差异,另一方面又可以进行同类医院医保质量的比较,还可以减少医保工作量。

To ascertain the settlement criterions of medical insurance expenditure,the method of cluster analysis was used.According to the their medical expenditure,scale and substantial results,46 hospitals was classified as 7 kinds.The average indexes including per time inpatient expenditures、the number of inpatient and per bed per day expenditure were difference among the different kinds of hospital.The chief distinction of each kind of hospital was discussed.There are many advantages using cluster analysis to determine the payment standard.It considers the difference of scale、service object and the categories of disease among different kind of hospitals On the other hand,the quality of medical insurance in the same kind of hospitals can be compared and the workload of medical insurance may be reduced.