摘要
在明确解决特定就医经济风险所需筹资额的基础上,考虑管理费用、风险储备金、补偿范围、补偿比、需求释放、医疗费用增长等因素,形成测算新农合筹资总额(总保险费)的思路和步骤,建立起"就医概率—就医费用—就医经济风险—解决特定风险筹资—需求增长—报销范围—补偿比"的动态关系;据此可形成保障水平、范围各异的多种筹资方案,并通过样本地区实际数据加以验证,确保了技术的可操作性。上述思路和方法为补偿方案的多种选择提供了理论依据,使新农合管理者在测算筹资中做到有理有据。
After nailing down the funds needed to address the specific financing risk, this study forms ideas and steps to measure the total premium of the New Rural Cooperative Medical System via considering the factors such as administrative expenses, risk reserve, scope of reimbursement, ratio of reimbursement, release of demand and the increasing medical expenses, and establishes dynamic relations of probability of hospitalization, medical expense, economic risk and funding needed to address specific financing risk, demand growth, scope of reimbursement and ratio of reimbursement so that it can form varying funding plans according to the insurance level and scope through a sample data to prove. The above mentioned ideas and methods provide theoretical basis for the multiple choices about reimbursement plans and gives ammunitions to the managers of NRCMS in terms of the measurement of funding.
出处
《中国卫生资源》
2013年第3期165-167,192,共4页
Chinese Health Resources
基金
教育部重大攻关项目(07JZD0017)
国家自然科学基金项目(70733002)
教育部创新团队项目(IRT0912)
复旦大学"985工程"三期整体推进社会科学研究项目(2011SHKXZD020)
关键词
新型农村合作医疗
筹资总额
测算
new rural cooperative medical system
total premium
measurement
