摘要
目的:探讨在社会医疗保险背景下住院者过度索赔的影响因素,提高医疗保险欺诈的识别概率。方法:通过检验和Logistic回归模型找出影响住院者过度索赔的因素。结果:住院者过度索赔的影响因素:住院费用、住院期间保健品的购买、报销费用时熟人的关照。结论:利用Logistic回归模型判断和预测医疗保险过度索赔发生的可能性大小,为欺诈行为的识别提供参考依据。
Objective To investigate the factors affecting excessive claims by inpatients under the circumstances of social medical insurance,to improve the recognition probability of medical insurance fraud. Methods The influence fac tors of excessive claims were found by Chi-- square test and Logistic regression model. Results The influence factors were hospitalization expenses,the purchase of health care products during hospitalization,and acquaintances＇ favor dur- ing reimbursement. Conclusions Logistic regression models are used to judge and predict the likelihood of excessive claims for medical insurance,which can provide reference for identifying fraud.
出处
《中国农村卫生事业管理》
2016年第6期693-696,共4页
Chinese Rural Health Service Administration
基金
教育部人文社会科学研究规划基金项目(13YJA630027)
山西省教育厅哲学人文社会科学课题(2011219)
关键词
医疗保险
过度索赔
影响因素
medical insurance
excessive claim
influence factor
