基于内蒙古自治区城乡居民基本医疗保险一体化的医药补偿费用测算

目的:测算内蒙古自治区不同补偿方案下医疗保险基金中的医药补偿费,研究内蒙古自治区城乡居民基本医疗保险一体化进程中的筹资可行性。方法:运用比值法、原始差分GM(1,1)模型、德尔菲法、移动平均等多种方法,对2015年内蒙古自治区不同补偿方案下的医药补偿费进行测算。结果:在尚未考虑起付线与封顶线等因素的前提下,五种医药补偿方案下所需筹资的医药总补偿费分别为:187.78亿元、253.55亿元、303.81亿元、323.46亿元及460.40亿元。结论:本研究通过对不同补偿方案下医药补偿费的测算,推算医疗保险一体化所需要的筹资额度,进而分析内蒙古自治区基本医疗保险筹资的可行性。在处理增长系数,保险因子等指标时,创新性地运用多种方法相结合的处理方式,科学、有效地计算了增长系数与保险因子,修正了部分年度增长系数增长幅度过大,保险因子数值偏高等问题,为准确评估医药补偿费奠定了良好的基础。

Calculation of medical compensation fee: Based on the integration of basic medical insurance for urban and rural residents in the Inner Mongolia Autonomous Region/Xue Qing-yuan, Sun Jing, Fan Yan-cun//

Objective: To study the medical compensation fee in medical insurance fund under different compensation schemes in Inner Mongolia Autonomous Region, and to study the feasibility of financing in the process of integration of basic medical insurance for urban and rural residents in Inner Mongolia Autonomous Region. Methods: Using the method of ratio method, original difference GM (1,1) model, Delphi method and moving average, the medical compensation fee under different compensation schemes in Inner Mongolia Autonomous Region in 2015 was calculated. Results: If we donot considering the factors such as pay line and cap line, the total compensation for medical expenses under the five medical compensation schemes was 18.778 billion yuan, 25.355 billion yuan, 30.351 billion yuan, 32.346 billion yuan, $ 46.04 billion. Conclusion: Based on the measurement of medical compensation under different compensation schemes, this paper calculates the amount of financing needed for the integration of medical insurance, and then analyzes the feasibility of financing the basic medical insurance in Inner Mongolia Autonomous Region. In the treatment of growth factors, insurance factors and other indicators, the innovative use of a variety of methods combined approach, scientific and effective calculation of the growth factor and insurance factor, revised part of the annual growth factor growth is too large, the insurance factor value is too high and other problem, in order to accurately assess the medical compensation