门诊共济改革背景下基于灰色模型的云南省职工医保基金可持续研究

Study on the Sustainability of Employee Medical Insurance Fund in Yunnan Province Based on Grey Model under the Background of Outpatient Co-Operation Reform

在人口老龄化问题日益凸显、疫情防控常态化的社会背景下,保障职工医保统筹基金安全和平稳运行是重中之重。文章以2011年至2021年云南省职工医保统筹地区基金累计结余、统筹基金收入与支出为研究数据,通过构建全数据GM(1,1)模型对职工医保基金收入、支出以及累计结余进行预测分析。职工医保基金灰色预测模型研究结果显示2011年至2021年云南省职工医保收入由108.2亿元增加到387.7亿元,支出从88.1亿元增加到300.1亿元,累计结余由120.1亿元增加到609.6亿元,云南省职工医保收支及累计结余均呈现逐年增长的态势。文章通过Excel建立的灰色GM(1,1)预测模型,实现了模型预测精度较高、拟合效果较好;云南省应进一步完善城镇职工医疗保险制度,不断深化医疗体制改革,从源头合理控制医疗费用增长,增加医保基金收入。

Under the social background of the increasingly prominent problem of population aging and the normalization of epidemic prevention and control, it is the top priority to ensure the safe and stable operation of the employee medical insurance pooling fund. This paper takes the cumulative balance of the fund, the income and expenditure of the pooling fund in Yunnan Province from 2011 to 2021 as the research data, and constructs the full data GM(1,1) model to predict and analyze the income, expenditure and cumulative balance of the employee medical insurance fund. The results of the grey prediction model of the employee medical insurance fund show that from 2011 to 2021, the income of the employee medical insurance in Yunnan Province increased from 10.82 billion yuan to 38.77 billion yuan, the expenditure increased from 8.81 bil-lion yuan to 3.01 billion yuan, and the cumulative balance increased from 12.01 billion yuan to 60.96 billion yuan. The income and expenditure of the employee medical insurance in Yunnan Province and the cumulative balance showed a trend of increasing year by year. In this paper, the grey GM(1,1) prediction model established by Excel achieves high prediction accuracy and good fitting effect. Yunnan Province should further improve the medical insurance system for urban workers, continuously deepen the reform of the medical system, reasonably control the growth of medical expenses from the source, and increase the income of the medical insurance fund.