中文摘要：

近几年医改的一个核心内容就是医保支付方式的改革。2012年12月，人力资源和社会保障部、财政部、卫生部三部门联合出台了《关于开展基本医疗保险付费总额控制的意见》，提出在未来两年里，在所有医疗保险统筹地区实行总额预付工作。实行总额预付制的关键是如何科学合理的测算每家医院的预算总额。本文利用线性混合效应模型分别对某市684家医院的病人数，平均费用进行建模，给出每一家医院来年医保费用的合理参考，并且利用模型中的随机效应项自动识别医保费用和病人数异常的医院，为医保监管机构的监管提供科学依据。

英文摘要：

In recent years, the core content of health reform is the reform of the medical insurance payment mode. In December 2012, HRSS, Ministry of Finance and Ministry of Health, the three depart- ments jointly issued that the opinions of implementation for controlling the total cost of basic medical insurance under global budget, and put forward that the global budget should be done in all medical insurance area in the next two years. The key of global budget is how to measurement total budget of each hospital reasonably. In this paper, we made detailed analysis with the data of medical insurance for urban workers. We use Linear Mixed-Effect Model to model the number of patients and average cost of inpatients. Our model has good fitting ability and applicability. We can give a reasonable reference to next year＇s budget, and provide scientific basis for health regulators.