医疗保障制度的效率分析：OECD国家的经验和启示

发布时间：2018-03-31 08:03

本文选题：医疗保障制度　切入点：效率　出处：《南开大学》2013年博士论文

【摘要】：长期以来,人们认为生命是无价的,政府、个人和家庭投入人力、财力、物力建立医院等机构获得医疗服务是为了身体健康着想,可以忽略或者不考虑成本。世界卫生组织报告表明在2000年到2009年人均医疗卫生费用从485美元增加到900美元,年增长率超过了6%,其中人均政府医疗卫生支出也从280美元增加到了549美元,增长了近2倍。随着全球性医疗卫生费用投入的不断增加,人们希望获得与之相应的医疗服务和卫生安全。但是事实上大量的医疗资源并没有转化为理想的医疗服务效果,普遍存在的医疗失误造成的医疗事故,患者花费了大量的资金没有达到理想的治疗效果而造成资金和医疗设备的浪费,医务人员技术的差异、临床试验的不足和监管不足等多种原因造成了医疗资源浪费,效率低下。此外,诸如道德风险和逆选择等医疗服务市场上的医患信息不对称问题都会使得医疗服务市场失效。因此,世界上绝大多数国家都通过建立医疗保障制度来干预医疗服务市场,保障人们获得健康的权利。但是在政府干预医疗服务市场的过程中同样面临着各种难题,诸如不健全的管理方法以及卫生系统的贿赂、欺诈行为造成了资金的浪费问题,政府缺乏专业的医疗技术知识来履行监管职能,政府财力有限难以独立支撑医疗保障制度运行的所有环节等等问题。尤其是在人口老龄化愈演愈烈的趋势下,一方面长期被居民诟病的“看病贵、看病难”问题没有彻底解决,另一方面,各国政府的医疗费用支出上涨压力巨大,政府面临着两难的局面。在此背景下,我们认为努力提高医疗保障制度的效率是缓解医疗费用上涨压力,充分发挥医疗服务市场功能的重要措施之一。基于这样的背景以及对我国的参考性和借鉴作用以及数据的性质和可得性等因素考虑,选择了OECD国家作为研究的对象展开对医疗保障制度效率问题的研究。我们借鉴前人的研究成果采用两步法进行研究：首先基于医疗保障制度的最终目标是提高健康水平这一事实,我们用健康生产效率来代表医疗保障制度效率,因此构建了健康生产函数,然后采用DEA方法和SFA方法来衡量医疗保障制度效率。第二步是衡量构建面板数据模型来衡量医疗保障制度效率的影响因素。论文的主要内容包含四大部分：首先是文献综述。我们分别从人力资本理论、卫生服务的公平性、医疗服务市场失灵和信息不对称三大方面对国内外学者近年来的相关研究成果进行了系统的梳理和分析。然后,从介绍效率理论基础和方法入手,进而对医疗保障制度效率的定义和当前的研究现状进行了详细的分析,系统阐述了学者们对这一问题的研究成果。其次是国际经验介绍。采用定性分析方法系统阐述OECD国家的典型医疗保障制度的运行情况。根据各国政府作用、公共医疗筹资、患者自付比例和低收入及老年人医保状况四个指标可将OECD国家的医疗保障制度划分为区域性全民公共医疗保障制度、国家医疗保障制度、法定医疗保障制度和商业医疗保障制度四种典型的模式,我们选择了实施上述四种医疗保障制度的七个国家来介绍他们各自的运行历史、运作情况及特点。再次,通过效率非参数法(选用了DEA方法)和效率参数法(选用了SFA方法)两种效率模型来考察OECD国家医疗保障制度效率的情况,试图分析医疗保障制度选择模式与其运行效率之间的关系。我们选择OECD国家作为研究对象,他们中既包括了美国、日本、英国、德国和法国等高收入国家,也包括了智利、墨西哥、土耳其这样的中等收入国家,而且它们分布在亚洲、欧洲、大洋洲、北美洲和南美洲,具有很强的代表性。不同的医疗保障制度模式有不同的筹资机制、保障水平、运行方式和管理方法,另外还受到各国经济社会等因素的影响,这就造成了不同的经济效率,那么是否存在着一种或者几种医疗保障制度模式本身就会产生较高的经济效率呢?我们希望通过比较分析来对其进行研究和测算,试图找到影响各国医疗保障制度效率的共性因素,于是在测算效率值的基础上,我们通过构建面板数据模型实证分析效率的影响因素,为进一步的效率改进提供理论和实证支持。最后是政策建议。与OECD国家类似,我们同样存在着医疗费用不断增加、医疗资源效率不高、看病贵和看病难等问题,而且由于城乡二元经济结构,我们还面临至今没有建立统一的医疗保障制度,居民医疗待遇差异大,商业医疗保险发展不足等问题,这些问题的解决都可以从OECD国家那里吸取经验并避免其不足。结合我国医疗保障制度的运行环境、实施状况和未来改革方向提出改善和提高我国医疗保障制度效率的建议。当然,这并不意味着我们可以完全复制OECD国家的医疗保障制度。
[Abstract]:For a long time , people think that life is priceless , the government , the individual and the family have invested human , financial and material resources to establish hospitals and other institutions to obtain medical services for the sake of physical health . The health care expenditure per capita is increased from US $ 485 to $ 549 . The annual growth rate is over 6 % . However , in fact , a large amount of medical resources have not been translated into the ideal medical service effect , the medical personnel technology difference , the shortage of clinical trials and inadequate supervision have caused the waste of medical resources and low efficiency . In addition , the asymmetry of medical information , such as moral hazard and adverse selection , will cause the medical service market to fail .

Therefore , most of the countries in the world have adopted a medical security system to intervene in the medical service market and guarantee the right of people to get healthy . In this context , the government lacks professional medical technology knowledge to carry out the research on the efficiency of medical security system . On the other hand , the government lacks professional medical technology knowledge to carry out supervision function , the government has limited financial resources to support the medical security system efficiency . In this context , we have constructed the health production function , then use the DEA method and SFA method to measure the efficiency of medical security system .

The main contents of the thesis include four parts :

Firstly , the paper reviews the research achievements of scholars in recent years from three aspects : the theory of human capital , the fairness of health service , the failure of medical service market and the asymmetry of information .

Secondly , it introduces the operation of typical health insurance system in OECD countries by adopting qualitative analysis method . According to the roles of governments , public health care financing , the proportion of patients ' self - payment and the status of low - income and old - aged health insurance , the health care system of OECD countries can be divided into four typical models of regional universal public health care system , national medical security system , statutory medical security system and commercial medical security system .

Thirdly , we choose the OECD countries as the research objects , including the high - income countries such as the US , Japan , the United Kingdom , Germany and France . We hope to find out the common factors that affect the efficiency of the medical security system in the United States , Mexico and Turkey .

Finally , it is a policy suggestion . Similar to the OECD countries , we also have the problems of increasing medical expenses , low efficiency of medical resources , lack of medical insurance and medical insurance .

【学位授予单位】：南开大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：F840.61;F842.684

【参考文献】