Study On The Risk Evaluation Of The Certified Hospitals In Region

Our social medical insurance fund should be ran with the pattern of"combination the social raising and the personal accounts"and the principle of"paying bases on raising,keeping the balance between paying and raising,having a bit of surplus". Otherwise, we may lose the economic guarantee of the social medical insurance systerm and can't keep the social medical insurance system running efficiently. With the development of the society and the economy, more and more risk factors will bring risks to the social medical insurance fund. Among them, the existence of the certified hospitals'risk results the medical cost being very difficult to control and the medical insurance fund being disequilibrium, then obstructs the reformation of the social medical insurance system.The paper mainly studies on the risk evaluation of the certified hospitals, introduces a new method to evaluate the risk of them, designs a comprehensive index system to evaluate the risk using Logistic and Fuzzy evaluation models through combining the quantitative indexes and the qualitative indexes. The paper provides a certain reference to the social medical insurance for further development and study.Firstly, the paper quantitatively appraises the regions'distribution of medical resources, provides a series of methods to solve the problem of how to allocate the medical resources efficiently and rationally. Secondly, from the Game theory points, the paper designs a rational model to control the certified hospitals'competitive performance and finally achieves a successful control to the certified hospitals'risk. Thirdly, the paper designs an index system to evaluate the risk of the regional certified hospitals, founds a Logistic evaluation model and a Fuzzy evaluation model to get a risk evaluation result. Lastly, the paper combines the two methods above, makes use of Fuzzy evaluation method again to design a comprehensive risk evaluation index system and evaluates the risk of the certified hospitals.