我国职工医疗保险基金全要素生产率及其区域特征分析——基于DEA和莫兰指数的研究

摘要/Abstract

摘要： 我国医疗保险经过20多年的改革发展，全民医疗保险目标已经实现，制度体系日趋成熟定型。鉴于医疗保险基金稳健运行是制度可持续发展的前提和基础，本文从医疗保险基金投入和产出两个方面，筛选衡量医疗保险基金全要素生产率的多个指标，构建医疗保险基金全要素生产率的评价指标体系，选取全国31个省份城镇职工基本医疗保险基金相关数据，采用DEA模型进行全要素生产率评价，并在此基础上利用莫兰指数分析了各地区间医疗保险基金全要素生产率的空间相关性，发现近年来我国城镇职工基本医疗保险基金全要素生产率总体上不断提高，但不同地区之间存在显著差异，特别是在2012年和2019年出现了显著的空间聚集效应。

关键词: 医疗保险基金, 全要素生产率, DEA, 莫兰指数

Abstract: As an important part of social insurance, medical insurance belongs to a typical public policy in China. Policy evaluation is an important issue of public policy management. After more than 20 years of reform and development, the goal of universal medical insurance has been achieved, and the system of medical insurance is becoming mature in China. Stable operation of Medical Insurance Fund in China is the premise and foundation for system sustainable development. From aspects of input and output of medical insurance fund, this paper screens the multiple indicators of fund total factor productivity, and constructs a total factor productivity evaluation index system of the medical insurance fund. Then the evaluation is proposed based on DEA model using related data from 31 provinces or cities in China. Further, the spatial correlation of total factor productivity of medical insurance fund is explored. The results show that in recent years the overall total factor productivity of medical insurance fund in China is constantly improved, but significant differences exist between different areas. Especially, there was significant spatial aggregation effect in 2012 and 2019.

Key words: medical insurance fund, total factor productivity, DEA, moran index

赵久洋, 郭琨. 我国职工医疗保险基金全要素生产率及其区域特征分析——基于DEA和莫兰指数的研究[J]. 管理评论, 2025, 37(2): 72-81.

Zhao Jiuyang, Guo Kun. Total Factor Productivity and Regional Characteristics of Medical Insurance Fund in China: Based on DEA and Moran Index[J]. Management Review, 2025, 37(2): 72-81.

参考文献

[1] 郑功成. 多层次社会保障体系建设:现状评估与政策思路[J]. 社会保障评论, 2019, 3(1):3-29 Zheng G. C. Construction of the Multilayered Social Security System:Evaluation and Policy Proposals[J]. Chinese Social Security Review, 2019, 3(1):3-29
[2] 王艳. 新冠肺炎疫情对民营经济高质量发展的影响及对策研究[J]. 管理评论, 2020, 32(10):11-21 Wang Y. Impact of COVID-19 Pneumonia Epidemic on High-quality Development of Private Economy and Countermeasures[J]. Management Review, 2020, 32(10):11-21
[3] 杨磊, 雷咸胜. 国内外医疗保险评估指标体系研究综述[J]. 社会保障研究, 2016, (3):98-104 Yang L., Lei X. S. A Review of the Research on the Evaluation Index System of Medical Insurance at Home and Abroad[J]. National Social Science Foundation of China, 2016, (3):98-104
[4] Avedis D. Evaluating the Quality of Medical Care[J]. The Milbank Memorial Fund Quarterly, 1966, 44(3):166-206
[5] Donabedian A. Evaluating the Quality of Medical Care[J]. Milbank Quarterly, 2010, 83(3):691-729
[6] Murray C. J., Frenk J. A Framework for Assessing the Performance of Health Systems[J]. Bull World Health Organ, 2000, 78(6):717-731
[7] Voorhoeve A., Ottersen T., Norheim O. F. Making Fair Choices on the Path to Universal Health Coverage:A Precis[J]. Health Economics Policy and Law, 2016, 11(1):71-77
[8] 徐强, 张开云, 李倩. 我国社会保障制度的建设绩效评价——基于全国四个省份1600余份问卷的实证研究[J]. 公共管理, 2015, (8):171-180 Xu Q., Zhang K. Y., Li Q. The Proposed Performance Evaluation of China's Social Security System Is Based on More than 1600 Questionnaires in Four Provinces across the Country[J]. Journal of Public Management, 2015, (8):171-180
[9] 申曙光, 瞿婷婷. 社会医疗保险基金收支风险评估研究——基于广东省A市的微观证据[J]. 华中师范大学学报(人文社会科学版), 2012, 51(6):47-55 Shen S. G., Qu T. T. Research on the Risk Assessment of Income and Expenditure of Social Medical Insurance Fund:Based on Micro Evidence from A City, Guangdong Province[J]. Journal of Central China Normal University(Humanities and Social Sciences), 2012, 51(6):47-55
[10] 赵吟. 城镇居民基本医疗保险评价体系构建研究[J]. 劳动保障世界, 2013, (8):35 Zhao Y. Research on the Construction of Evaluation System of Basic Medical Insurance for Urban Residents[J]. The World of Labor Security, 2013, (8):35
[11] 赵文龙, 郑美雁. 我国城镇职工基本医疗保险评价指标体系的构建[J]. 统计与决策, 2005, (3):36-37 Zhao W. L., Zheng M. Y. The Construction of the Evaluation Index System of Basic Medical Insurance for Urban Workers in China[J]. Statistics and Decision, 2005, (3):36-37
[12] 于大川. 城镇居民医疗保险是否促进了医疗服务利用?——一项对制度运行效果的实证评估[J]. 金融经济学研究, 2015, 30(5):117-128 Yu D. C. Does Basic Medical Insurance for Urban Residents Raise Medical Service Utilization?-An Empirical Evaluation of System Running Effect[J]. Journal of Finance and Economics, 2015, 30(5):117-128
[13] 李辉. 城镇职工基本医疗保险统计指标体系构建研究[J]. 公共管理, 2015, (8):117-118 Li H. Research on the Construction of Statistical Index System of Basic Medical Insurance for Urban Employees[J]. Journal of Public Management, 2015, (8):117-118
[14] Puig-Junoy J. Measuring Health Production Performance in the OECD[J]. Applied Economics Letters, 1998, (5):255-259
[15] Retzlaff-Roberts D., Chang C. F., Rubin R. M. Technical Efficiency in the Use of Health Care Resources:A Comparison of OECD Countries[J]. Health Policy, 2004, 69(1):55-72
[16] Bruce H., John W. The Efficiency of Health Production:Re-estimating the WHO Panel Data Using Parametric and Non-parametric Approaches to Provide Additional Information[J]. Health Economics, 2003, (12):493-504
[17] Juan C. G. Evaluation of the Efficiency of European Health Systems Using Fuzzy Data Envelopment Analysis[J]. Healthcare, 2021, (9):1270
[18] Ahmed S., Hasan M. Z., Maclennan M., et al. Measuring the Efficiency of Health Systems in Asia:A Data Envelopment Analysis[J]. BMJ Open, 2019, 9(3):e022155
[19] Kawaguchi H., Tone K., Tsutsui M. Estimation of the Efficiency of Japanese Hospitals Using a Dynamic and Network Data Envelopment Analysis Model[J]. Health Care Management Science, 2014, 17(2):101-112
[20] Achoki T., Hovels A., Masiye F., et al. Technical and Scale Efficiency in the Delivery of Child Health Services in Zambia:Results from Data Envelopment Analysis[J]. BMJ Open, 2017, 7(1):e012321
[21] 孙健, 申曙光. 新型农村合作医疗制度运行质量的评价指标体系设计[J]. 统计与决策, 2009, (7):16-19 Sun J., Shen S. G. Design of Evaluation Index System for the Operation Quality of the New Rural Cooperative Medical System[J]. Statistics and Decision, 2009, (7):16-19
[22] 王菁, 魏建. 竞争、医疗保险与宏观医疗效率——基于DEA模型的两阶段分析[J]. 经济问题, 2013, (4):17-21 Wang J., Wei J. Competition, Insurance and Efficiency of Hospital Market:Based on the Two Stage Analysis of DEA Model[J]. On Economic Problems, 2013, (4):17-21
[23] Sun J., Luo H. Y. Evaluation on Equality and Efficiency of Health Resources Allocation and Health Services Utilization in China[J]. International Journal for Equity in Health, 2017, (16):127
[24] Liam O. N., Marion R. A Cross-national Comparison and Taxonomy of DEA-based Hospital Efficiency Studies[J]. Socio-Economic Planning Sciences, 2008, 42(3):158-167
[25] 于本海, 智荣腾, 郭林, 等. 不确定信息环境下的医疗保险基金绩效评价模型[J]. 管理学报, 2018, 15(12):1862-1871 Yu B. H., Zhi R. T., Guo L., et al. Performance Evaluation Model of Medical Insurance Funds in Uncertain Information Environment[J]. Chinese Journal of Management, 2018, 15(12):1862-1871
[26] 彭锻炼. 地方政府社会保险服务绩效评价指标体系构建与绩效测度[J]. 中央财经大学学报, 2015, (1):19-26 Peng D. L. Construction of Performance Index System and Performance Measurement on Socialinsurance of Local Government[J]. Journal of Central University of Finance & Economics, 2015, (1):19-26
[27] 姚金海. 人口老龄化, 养老金收支缺口与财政风险的传导与化解——以A市为例的一项实证研究[J]. 管理评论, 2016, 28(4):68-72 Yao J. H. The Conduction and Resolution of Population Aging, Pension Income Gap and Financial Risk-An Empirical Study of City A[J]. Management Review, 2016, 28(4):68-72
[28] 苗文龙, 周潮. 人口老龄化, 金融资产结构与宏观经济波动效应[J]. 管理评论, 2020, 32(1):56-67 Miao W. L., Zhou C. Chinese Aging Problem and Its Effect on Financial Asset and Macroeconomic Fluctuations[J]. Management Review, 2020, 32(1):56-67
[29] 祁毓, 卢洪友. 危机还是转机:经济周期中的国民健康[J]. 中国软科学, 2015, 22(12):36-48 Qi Y., Lu H. Y. Crisis or Turning Point:The National Health in Economic Cycle[J]. China Soft Science, 2015, 22(12):36-48
[30] 潘桔, 郑红玲. 区域经济高质量发展差异的时空演变特征[J]. 统计与决策, 2021, 37(24):88-92 Pan J., Zheng H. L. Spatial and Temporal Evolution Characteristics of Regional High-quality Economic Development Differences[J]. Statistics and Decision, 2021, 37(24):88-92
[31] 叶江峰, 姜雪, 井淇, 等. 整合型医疗服务模式的国际比较及其启示[J]. 管理评论, 2019, 31(6):199-212 Ye J. F., Jiang X., Jing Q., et al. International Comparison and Enlightenment of Integrated Health Services Models[J]. Management Review, 2019, 31(6):199-212