Clinical Expenditure Of Out-Patient Prediction Research For Worker Under The Medical Insurance System In Nanning With The Three Chronic Diseases

Objective This research analyzes the operation situation of chronic disease compensation system about hypertension, diabetes, coronary heart disease from 2013to 2015. It also uses the autoregressive moving average model (A model) to predict average outpatient expenses of the three chronic diseases. Then, according to the result of prediction, the paper carries on the preliminary analysis and evaluation about "Beibu Gulf integration" policy, and provides the reference opinions and policy suggestion to the Institutes of Health about how to make the chronic disease compensation system more perfect and how to respond to expense growth.Methods We uses qualitative and quantitative methods to analyze the operation situation of chronic disease compensation system about hypertension, diabetes and coronary heart disease for the fundamental medical insurance system of urban employee in Nanning from 2013 to 2015. We use Eviews 8.0 statistical software to make Time Series Analysis. We Select the optimal model after model establishing, model diagnosis and validation. Then, we use the optimal model to forecast the average outpatient expense of the chronic disease patient who are the urban employee of fundamental medical insurance system in Nanning in 2016. At last, we analyze and evaluate "Beibu Gulf Integration" policy about health care treatment according to a comprehensive analysis of the situation of compensation cost and the result of prediction.Results In 2013-2015, clinic visits of the three kinds of chronic diseases were gradually growing by year to year. In 2013-2014, the clinic visits rised faster. There were no differences in clinical expenditure of out-patient of the three chronic disease between 2013 to 2015. From 2013 to 2015, the proportion of health care payments was about 60%. In 2014, the payments proportion of the three chronic diseases respectively drop in 6%,7% and 7%. From 2013 to 2014, the every proportion of the western medicine expenses paid on the chronic diseases was over 95%. But, the proportion all fell to 85% in 2015.We forecast the clinical expenditure of out-patient of hypertension, diabetes and coronary heart disease from 2015 to 2016. Through the model identification, parameter estimation, model establishing, model diagnosis and evaluation, we respectively obtain the optimal model of ARIMA (2,1,2), ARIMA (2,1,2), ARIMA (2,2,3) for hypertension, diabetes and coronary heart disease, and estimate the clinical expenditure of out-patient,254,329,266. In 2016, a total compensation in health care expense accounts for 50%,55% and 51%.Conclusion ARIMA model can well predict the treatment cost of the chronic disease and it provides technical support and helps decision-making for cost control and the compensation treatment adjustment. At the same time, the model provide a reference for other chronic diseases forecasting research, so it has strong application value. Under the implementation of "Beibu Gulf Integration" policy, the actual compensation proportion in 2015 fall down, compared with 2014, the proportion of three chronic diseases all keeps 50%. With the the increasing of clinical expenditure, compensation proportion grows. When the treatment cost of the chronic disease per time reaches 400, the medical standards co-ordination,5500, cannot meet the needs of patients with chronic diseases. this requires we start to seek breakthroughs and find a solution.