本文選題：深圳市　切入點(diǎn)：住院醫(yī)療費(fèi)用　出處：《華中科技大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的從一般特征和住院費(fèi)用等方面，比較深圳市三種醫(yī)療保險(xiǎn)類型的差異。探討影響參�；颊咦≡嘿M(fèi)用的因素，對醫(yī)療保險(xiǎn)基金住院支出金額進(jìn)行準(zhǔn)確預(yù)測。為控制醫(yī)療費(fèi)用，保障基金收支平衡，完善醫(yī)保制度建設(shè)和醫(yī)藥衛(wèi)生體制改革提供參考。方法本研究以深圳市2010年7月—2011年6月，綜合醫(yī)療保險(xiǎn)、住院醫(yī)療保險(xiǎn)和農(nóng)民工醫(yī)療保險(xiǎn)三種醫(yī)療保險(xiǎn)的參保人為研究對象，共納入?yún)⒈Ｈ?44096人。應(yīng)用描述性分析、卡方檢驗(yàn)和非參數(shù)檢驗(yàn)的方法，比較不同參保類型的差異；應(yīng)用廣義線性回歸模型分析醫(yī)療保險(xiǎn)患者住院費(fèi)用的影響因素。應(yīng)用時(shí)間序列模型ARIMA，對2003到2010年度住院醫(yī)療統(tǒng)籌基金支出進(jìn)行擬合和預(yù)測。采用Excel、SPSS l3.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析。 結(jié)果 1.三種參保類型比較: 三種參保類型的性別、戶籍類型、職工類別、年齡構(gòu)成情況的差異有統(tǒng)計(jì)學(xué)意義。農(nóng)民工醫(yī)療保險(xiǎn)特點(diǎn)突出，參保人為非深圳戶籍勞務(wù)工人員，男性比例大，年齡結(jié)構(gòu)偏輕。住院總費(fèi)用、藥費(fèi)、診療費(fèi)、報(bào)銷比例等在三種參保類型間的差異有統(tǒng)計(jì)學(xué)意義。農(nóng)民工醫(yī)療保險(xiǎn)整體處于偏低水平。 2.住院總費(fèi)用的影響因素： 對住院總費(fèi)用影響因素分析顯示，性別、戶籍類型、職工類別、年齡、參保類型、住院次數(shù)、報(bào)銷比例均為影響住院總費(fèi)用的因素（P0.001）。 3.住院醫(yī)療統(tǒng)籌基金支出預(yù)測 對住院醫(yī)療統(tǒng)籌基金支出進(jìn)行預(yù)測，得到ARIMA(0，1，1)(0，1，0)12模型，平均相對誤差為3.00%，顯示預(yù)測值對住院統(tǒng)籌基金支出有很好的預(yù)測效果。 結(jié)論深圳市三種醫(yī)療保險(xiǎn)各有特色，農(nóng)民工醫(yī)療保險(xiǎn)籌資和保障水平低，，綜合醫(yī)療保險(xiǎn)人群的年齡和職工類別較均衡。住院醫(yī)療費(fèi)用受住院次數(shù)、報(bào)銷比例等因素影響。應(yīng)用ARIMA模型對住院醫(yī)療統(tǒng)籌基金支出預(yù)測，顯示了很好的預(yù)測效果，可用于基金預(yù)測。
[Abstract]:Objective to compare the differences among the three types of medical insurance in Shenzhen from the aspects of general characteristics and hospitalization expenses. To explore the factors affecting the hospitalization expenses of insured patients, and to predict accurately the amount of hospitalization expenses of the medical insurance fund in order to control the medical expenses. To ensure the balance of income and expenditure of the fund, to improve the construction of the medical insurance system and the reform of the medical and health system. Methods this study is based on the comprehensive medical insurance in Shenzhen from July 2010 to June 2011. The participants of three kinds of medical insurance including hospitalization medical insurance and migrant workers' medical insurance were taken as the research object, which included 244096 insured persons. Using descriptive analysis, chi-square test and non-parametric test, the differences of different insured types were compared. The influencing factors of hospitalization expenses of medical insurance patients were analyzed by using generalized linear regression model, and the expenditure of hospital medical plan fund was fitted and predicted by time series model Arima. The statistical software of Excel SPSS l 3.0 was used to carry out statistical analysis. Results. 1. Comparison of three types of insurance:. The differences of sex, household registration type, employee category and age composition of the three types of insurance are statistically significant. The characteristics of migrant workers' medical insurance are prominent, and the insured persons are non-Shenzhen household registered workers, with a large proportion of men. The difference of total hospitalization expenses, medical expenses, medical expenses, reimbursement ratio among the three types of insurance is statistically significant. The overall level of medical insurance for migrant workers is on the low side. 2. Factors affecting total hospitalization costs:. The analysis of the factors influencing the total cost of hospitalization showed that gender, household registration type, employee type, age, type of insurance, times of hospitalization and reimbursement ratio were all the factors affecting the total cost of hospitalization (P 0.001). 3. Expenditure forecast of the inpatient health care coordination fund. The ARIMA model was obtained, and the average relative error was 3.00, which showed that the predicted value had a good effect on the inpatient fund expenditure. Conclusion the three kinds of medical insurance in Shenzhen have their own characteristics, the level of financing and security of medical insurance for migrant workers is low, the age and the type of workers are more balanced, and the hospitalization costs are more frequent. The application of ARIMA model to the forecast of inpatient medical fund expenditure shows a good effect and can be used to forecast the fund.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R197.1;F842.684

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