【作者】 王柯；

【导师】 闵捷； 张晓；

【作者基本信息】 东南大学 ， 流行病与卫生统计， 2006， 硕士

【摘要】 本研究旨在对江苏省铜山县新型农村合作医疗的补偿方案进行研究,包括探讨新型农村合作医疗损失分布;结合政策、理论研究和实践经验,比较多种补偿方案的优劣;并根据方案优化结果、损失分布预测和筹资标准的变化,提出补偿方案调整的建议。利用保险精算理论中的损失分布及其研究工具对江苏省铜山县新型农村合作医疗的损失分布进行了分析,结果表明参加新型农村合作医疗农民的住院次数近似服从负二项分布,次住院费用服从波尔分布。结合损失分布可计算理论上完全补偿农民医疗费用所需的纯保费。根据政策、理论研究和实践经验总结,拟定了多种补偿方案,运用TOPSIS法进行比较优化后,提出了以大病统筹为主,大病补偿设置一定起付线,分两段补偿,重点补偿大病费用段,设置一定封顶线的补偿方案思路。结合损失分布的预测和方案优化的结果,模拟了补偿方案调整的过程。研究表明在无重大疾病流行,且补偿水平和补偿政策不发生重大变化下,利用历史住院费用损失分布与费用增长系数可有效预测未来的损失分布。进一步验证了波尔分布在拟合新型农村合作医疗损失分布上的良好效果。在预测未来年度损失分布的基础上,根据方案的优化结果,结合该县的筹资标准变化,提出了补偿方案调整的建议。更多还原

【Abstract】 The aim of the study is to research the New Rural Cooperative Medical Scheme Indemnity Plan in Tongshan county, Jiangsu province, explore the loss distribution of New Rural Cooperative Medical Scheme, combine the policy, theory study and practicing experience, evaluate several indemnity plans, then present suggestion on indemnity plans’adjusting ,according to the plan optimizing result and the changing of loss distribution and premium.The loss distribution and it’s study tools in insurance actuarial is used to analysis the loss distribution of New Rural Cooperative Medical Scheme, it is shown that for the farmers in New Rural Cooperative Medical Scheme, their hospitalization counts mostly has an Negative Binomial distribution, and their each hospitalization cost has an Burr distribution. The net premium ensuring the whole medical cost can be calculated by using the loss distribution.Based on the policy, theory study and practicing experience, several indemnity plans are presented, then the TOPSIS method is used to optimize them and the optimized plan is selected, which focuses on high-cost disease, has a deductible, indemnifies in two parts, emphasises on high-cost part, and has a maximum.Finally the indemnity plans’adjusting is simulated, based on the loss distribution predicting and optimizing result. It is shown that if there is no dread disease prevalence, and the indemnity level and policy has no changing, the loss distribution of next year can be predicted by the previous loss distribution and the cost increment rate. Furthermore, it is validated that the Burr distribution can fit the loss distribution of New Rural Cooperative Medical Scheme effectively. Based on the predicted loss distribution and optimizing result, according as the premium, the suggestion of plan adjusting is presented.更多还原