CAJ | 학술논문

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1179户农村家庭4433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1000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。
목적：탐토몽특잡라모의기술재아국신형농촌합작의료（신농합）보상방안우화조정중적응용。방법채용다계단수궤추양방법재광동성사회시13개향진（가도）조사1179호농촌가정4433인，획득모의소수적기본삼수。채용Probit개솔회귀모형의합수거，계산출삼가신농합자대각급의료궤구적수구개격탄성여교차탄성계수。채용몽특잡라모의기술매차모의추양500호，공추취1000차，측산매충비선보상방안적각보상효응지표치，종이우화현유보상방안。결과문진、위생원、이급의원화삼급의원적주원수구개격탄성분별위-0.174、-0.264、-0.675화-0.429，균처우결핍탄성상태；문진수구량환수도위생원화이급의원주원개격적영향，기교차탄성계수분별위0.125화0.150。비선방안B7적기금사용효솔체도17.85%，총보상비위25.63%，해결인병치빈솔위18.25%，비현집행적보상방안제고9.37%，표명현유방안응조정우화。결론이용몽특잡라모의기술가대아국신농합보상효응진행모의측산，위우화신농합보상방안제공측산신방법。
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.