摘要
目的:分析我国基本医疗保险制度全覆盖、整合及DRG/DIP支付方式改革对卫生服务利用和资源配置公平性的影响。方法:利用1998—2022年我国卫生服务利用和资源面板数据,采用集中指数和泰尔指数衡量卫生公平性,通过BP神经网络和中断时间序列分析基本医疗保险制度改革对我国卫生公平性的影响。结果:基本医疗保险制度全覆盖、整合及DRG/DIP支付方式改革对卫生人员数、床位数和入院人次数有正向影响(均为P<0.001),对人均住院费用增长有抑制作用(P<0.05)。基本医疗保险全覆盖后,卫生人员数和床位数的集中指数每年下降0.004和0.003,且滞后5年仍每年均下降0.002(均为P<0.05)。入院人次数的集中指数在DRG/DIP支付方式改革后立即下降了0.014,之后每年下降0.012(均为P<0.001)。结论:基本医疗保险制度改革不仅可以促进卫生服务利用和资源增长,而且可以提高卫生公平性,此外还产生了促使卫生公平性改善的滞后效应。
Objective:To analyze the impact of the universal coverage,integration and DRG/DIP payment method reform of Basic Medical Insurance(BMI)on the equity of the health service utilization and resource allocation.Methods:The 1998-2022 panel data on health service utilization and resources were collected for China.Health equity is measured using the Concentration Index(CI)and Theil index,and the impact of BMI reform on health equity is analyzed by BP neural network and ITSA.Results:Universal coverage,integration,and DRG/DIP payment reform of BMI had a positive effect on the number of health workers,beds,and admissions(P<0.001),and inhibited the growth of per capita hospitalization costs(P<0.05).The CI for the number of health workers and beds declined by 0.004 and 0.003 per year after universal coverage of BMI;and both still declined by 0.002 per year with a 5-year lag(P<0.05).The CI for the hospital admissions fell by 0.014 immediately after the DRG/DIP payment reform and by 0.012 per year thereafter(P<0.001).Conclusion:BMI reforms not only can contribute to improve the health service utilization and resources,but also it can also improve health equity.In addition,it has a lagged effect on improving health equity.
作者
张程
林燕铭
杨越涵
候丽莎
黄菊
Zhang Cheng;Lin Yanming;Yang Yuehan(Institute of Medical Information/Library,Chinese Academy of Medical Sciences,Beijing,100020,China;不详)
出处
《中国卫生经济》
北大核心
2025年第10期11-15,共5页
Chinese Health Economics
基金
国家社会科学基金青年项目(23CGL071)。
