新农合对医疗服务利用影响的实证研究

发布时间：2019-01-11 18:28

【摘要】：新型农村合作医疗制度(新农合)是我国农村医疗卫生体系的一个重大变革。它由政府组织、引导和支持,农村居民自愿选择参加,是一个以大病统筹为主的农民医疗互助共济的制度。自2003年新农合在我国部分县市试点推行以来,参加的人数以年均34%的速度增长。到了2010年新农合已经基本覆盖全国所有的农村居民。然而新农合的实施效果究竟如何,近年来国内外众多学者也没有达成一致的结论。本论文根据中国健康与营养调查2006年和2000年的数据,分别利用普通最小二乘法、倾向分数匹配法以及倾向分数匹配基础上的倍差分析法来对新农合的实施效果进行评价。考察了两个方面的指标：医疗服务的利用以及居民的就医行为。其中医疗服务的利用包括四周住院率和四周门诊率,居民的就医行为包括患病没有去看的比例。普通最小二乘法存在选择偏差和遗漏变量的问题,而倾向分数匹配法仅利用了2006年的数据,没有同新农合实施之前的情况进行比对分析,忽略了随时间变化的因素产生的影响。倾向分数匹配基础上的倍差分析法利用了两次调查的数据,克服了以上两种方法的不足之处,得到的结论相对更加准确。本文的实证研究为进一步完善新农合提供了一定的参考价值。通过实证分析发现,新农合对提高农村居民的四周住院率和四周门诊率的效果都比较显著。然而新农合并没有显著地降低农村居民患病没有去看的比例。通过进一步的研究发现,新农合显著地提高了农村居民患病后选择自己治疗的比例,其原因可以归为我国农村地区近年来药店数目的增加方便了居民就近看病治疗,而到距离最近的医疗机构看病仍然不太方便。
[Abstract]:The new rural cooperative medical system (NCMS) is a major reform of rural health system in China. It is organized, guided and supported by the government, and the rural residents choose to participate voluntarily. Since the NCMS was carried out in some counties and cities in 2003, the number of participants has increased by 34% per year. By 2010, NCMS had basically covered all the rural residents of the country. However, in recent years, many scholars at home and abroad have not reached an agreement on the implementation effect of NCMS. Based on the data of China Health and Nutrition Survey in 2006 and 2000, this paper evaluates the effect of NCMS by using the ordinary least square method, the tendency fraction matching method and the double difference analysis method based on the tendency score matching method, respectively. Two indicators were examined: the utilization of medical services and the behavior of residents seeking medical treatment. The utilization of medical service includes four week hospitalization rate and four week outpatient rate. The ordinary least square method has the problems of selecting deviation and missing variables, while the tendency fraction matching method only uses the data from 2006, and does not compare with the situation before the implementation of NCMS, neglecting the influence of the factors changing with time. The double difference analysis method based on propensity score matching makes use of the data from two surveys to overcome the shortcomings of the above two methods and the conclusion is more accurate. The empirical research in this paper provides a certain reference value for the further improvement of NCMS. Through empirical analysis, it is found that NCMS has a significant effect on increasing the four-week hospitalization rate and four-week outpatient rate of rural residents. However, the amalgamation of new farmers did not significantly reduce the proportion of rural residents who did not go to see the disease. Through further research, it is found that NCMS has significantly increased the proportion of rural residents choosing their own treatment after illness, and the reason can be attributed to the increase in the number of pharmacies in rural areas of China in recent years, which facilitates the residents to see a doctor nearby. It is still not convenient to see a doctor at the nearest medical institution.
【学位授予单位】：华东师范大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684;F323.89;R197.1

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