基于ProModel仿真建模的医保基金收支预测研究：以黑龙江省为例

目的:在医保基金收支压力持续增加的背景下,探讨通过构建医疗保障制度Pro Model仿真模型,模拟并预测未来五年医保基金的收支状况。方法:构建医疗保障制度Pro Model仿真模型。以2010—2014年黑龙江省医保数据为基础数据,同时以2014年数据为基准,保持各变量2010—2014年间增长趋势,预测未来五年的医保收支状况。结果:模拟预测显示,2018年黑龙江三大医保基金整体收支面临失衡风险,新型农村合作医疗及城镇居民医保将入不敷出;城镇职工医保虽然保持收支平衡,但结余额也逐渐减少。结论:加强医保基金收支风险管理是当前医保制度管理的重点。

Study on medical insurance fund revenue and expenditure prediction based on ProModel simulation modeling

Objective: In the context of the continuous increase in the balance of payment of medical insurance funds, simulate and predict the balance of payment of medical insurance fund in the next five years by build ProModel simulation model of medical insurance system . Methods: Constructing ProModel simulation model of medical insurance system. Based on the data of Heilongjiang medical insurance in 2010-2014 years, on the basis of 2014 data, and maintain the growth trend of the variables over the past 2010-2014 years predict the health insurance revenue and expenditure in the next five years. Results: Simulation results showed that Heilongjiang basic medical insurance fund revenue and expenditure facing the imbalance risk in 2018. NCMS and MIUR will make ends meet and although MIUW will keep balance in payments, the balance will gradually decrease. Conclusion: Strengthen the health insurance fund revenue and expenditure risk management is the focus of the current health insurance system management