基于流率基本入树模型的儿童基本医疗保险优化研究*

目的：探寻影响儿童基本医疗保险稳定运行的关键性变量,为其优化提出针对性建议。方法：利用Vensim软件建立儿童居民医保系统流率基本入树模型,结合流率基本入树嵌运算及枝向量矩阵反馈环计算法确定极小基模。结果：儿童居民医保缴费金额、儿童居民医保报销标准、参保儿童基层就诊人次、基层医疗机构儿童诊疗质量及政府对基层医疗机构的资源投入为影响儿童基本医疗保险稳定运行的关键变量。结论：应合理设置儿童居民医保筹资标准与报销标准,完善基层医疗机构人才激励制度,提升基层医疗机构儿童诊疗质量,合理配置医疗资源。

Research on the Optimization of Children Basic Medical Insurance Based on Basic Tree Model of Flow Rate

Objective: To explore the key variables affecting the stable operation of children basic medical insurance and put forward specific suggestions for its optimization. Methods: Vensim Software is used to establish the basic tree entry model of the flow rate of the children resident medical insurance system, and the minimal fundamental model is determined by combining the basic tree entry operation and the branch vector matrix feedback loop calculation method. Results: Key variables affecting the stable operation of basic medical insurance for children are the payment amount of medical insurance for children residents, the reimbursement standard of medical insurance for children residents, the number of insured children visiting the basic medical institutions, the quality of medical treatment for children in basic medical institutions, and the government'' s resource investment in basic medical institutions. Conclusion: It is needed to reasonably set the financing standard and reimbursement standard of medical insurance for children, improve the talent incentive system in primary medical institutions, develop the quality of children''s diagnosis and treatment in primary medical institutions, and rationally allocate medical resources.