文章摘要
孟雪晖,黄奕祥,吴少龙,柳青.利用蒙特卡罗模拟技术对我国新型农村合作医疗补偿方案的优化测算[J].中华流行病学杂志,2014,35(6):664-668
利用蒙特卡罗模拟技术对我国新型农村合作医疗补偿方案的优化测算
Study on optimizing the reimbursement scheme under the New Rural Cooperative Medical System,based on Monte Carlo simulation
收稿日期:2013-11-16  出版日期:2014-09-02
DOI:
中文关键词: 蒙特卡罗模拟  新型农村合作医疗  补偿方案  补偿效应
英文关键词: Monte Carlo simulation  New Rural Cooperative Medical System  Reimbursement scheme  Reimbursement effect
基金项目:
作者单位E-mail
孟雪晖 325000 温州医科大学人文与管理学院卫生管理系  
黄奕祥 中山大学公共卫生学院卫生管理系  
吴少龙 中山大学公共卫生学院卫生管理系  
柳青 肿瘤防治中心流行病学室 liuqingsysu@aliyun.com 
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中文摘要:
      目的 探讨蒙特卡罗模拟技术在我国新型农村合作医疗(新农合)补偿方案优化调整中的应用。方法 采用多阶段随机抽样方法在广东省四会市13 个乡镇(街道)调查1 179 户农村家庭4 433 人,获得模拟所需的基本参数。采用Probit 概率回归模型拟合数据,计算出参加新农合者对各级医疗机构的需求价格弹性与交叉弹性系数。采用蒙特卡罗模拟技术每次模拟抽样500 户,共抽取1 000 次,测算每种备选补偿方案的各补偿效应指标值,从而优化现有补偿方案。结果 门诊、卫生院、二级医院和三级医院的住院需求价格弹性分别为-0.174、-0.264、-0.675和-0.429,均处于缺乏弹性状态;门诊需求量还受到卫生院和二级医院住院价格的影响,其交叉弹性系数分别为0.125 和0.150。备选方案B7 的基金使用效率达到17.85%,总补偿比为25.63%,解决因病致贫率为18.25%,比现执行的补偿方案提高9.37%,表明现有方案应调整优化。结论 利用蒙特卡罗模拟技术可对我国新农合补偿效应进行模拟测算,为优化新农合补偿方案提供测算新方法
英文摘要:
      Objective To explore the application of Monte Carlo simulation in optimizing and adjusting the reimbursement scheme with regard to the New Rural Cooperative Medical System (NCMS)to scientific steering practice. Optimization of the reimbursement scheme in rural areas of China was also studied. Methods A multi-stage sampling household survey was conducted in Sihui county,with 4 433 rural residents from 1 179 households from 13 towns in Guangdong province surveyed by self-designed questionnaire. Probit Regression Model was applied in fitting data and then estimating the own-price elasticity and cross elasticity of healthcare demand for both outpatients and inpatients. Monte Carlo simulation model was constructed to estimate the reimbursement effects of various alternative reimbursement schemes,by replicated simulation for one thousand times and each sampling on five hundred households. In this way,optimization of the implemented reimbursement scheme in Sihui county was conducted. Results Own-priced elasticity of demands for outpatient visit,inpatient visit in the township hospital center,secondary hospital and tertiary hospital were -0.174,-0.264,-0.675 and -0.429,respectively. Outpatient demand was affected by the per-visit price of township hospital center and secondary hospital. The cross-priced elasticity of demands for outpatient visit appeared to be 0.125 and 0.150. The reimbursement effects of Scheme B7 showed that the efficiency of NCMS fund was 17.85%,the reimbursement ratio for healthcare was 25.63%,and the decreased percentages of poverty caused by illness was 18.25%,more than 9.37%, from the implemented scheme A. So the implemented scheme was in need for optimization. Conclusion Monte Carlo simulation technique was applicable to simulate the effects of the optimized alternative reimbursement scheme of NCMS and it provided a new idea and method to optimize and adjust the reimbursement scheme.
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