基于改进DEA-Tobit的医疗保障体系效率评价研究

发布时间：2018-10-19 15:04

【摘要】：医疗保障体系是国家为保障居民健康水平抵御疾病所带来的健康、经济等风险而建立的包括筹集、分配、使用医疗保障基金的保障体系。为保障生命的健康,政府、社会、个人和家庭在健康投入方面不遗余力,我国医疗总费用从2000年的5000亿元至2014年已达到35379亿元,其增长速度大幅超过了同期我国GDP的增速,其中政府卫生支出所占比例逐年增高,在2014年达到29.9%。然而如此大量投入的医疗保障及卫生资源仍然没有降低个人医疗费用的支出,"看病贵、看病难"的问题依然凸显,政府压力逐年增大但实际问题却没有彻底解决,使得对于医疗保障体系运行状态进行全面分析的需求尤为重要。本文以国家自然科学基金重点项目"大数据驱动的智慧医疗健康管理创新"为依托,针对评估医疗保障体系运行状态及问题的需求,提出使用效率理念对其进行全面分析。首先,通过对国内外成果及文献进行研究,结合医疗保障体系特点与效率等理论确定研究方法为数据包络分析,并对当前DEA在医疗保障领域的应用进行归纳总结,发现当前使用较多的DEA基础模型存在诸多局限性;第二,提出改进DEA-Tobit两阶段模型分析医疗保障体系效率,即在使用DEA分析内部因素的同时引入PanelData-Tobit模型对于外部解释变量进行面板数据回归确定其影响关系,除此之外对于基本DEA模型进行改进与扩展,提出非导向型规模报酬可变模型及排除当前决策单元的相对有效性模型,并引入Malmquist生产率指数方法构建医疗保障体系运行效率评价模型;第三通过文献分析与统计分析相结合的方式,基于健康生产函数相关理念选取投入及产出指标,建立一套医疗保障体系运行效率的评价指标体系;最后选取我国31个省份2011-2014年共计124个决策单元进行实证分析,并以效率结果作为被解释变量,引入经济、政府、城镇化、老龄化、教育水平、就业情况、医疗卫生投入等指标作为解释变量,对其与被解释变量之间的相关关系进行分析,结合效率评价结果,对我国医疗保障体系提出相应的改进策略及建议。
[Abstract]:The medical security system is established by the state to protect the health level of the residents against the health and economic risks brought by the disease, including raising, distributing, and using the medical security fund. In order to safeguard the health of life, the government, society, individuals and families spare no effort in health investment. The total medical cost of our country has reached 3.5379 trillion yuan from 500 billion yuan in 2000 to 3.5379 trillion yuan in 2014, and its growth rate has greatly exceeded the growth rate of GDP in the same period. The proportion of government health expenditure has increased year by year, reaching 29.9% in 2014. However, such a large amount of medical security and health resources have still not reduced the expenditure of personal medical expenses. The problem of "expensive and difficult to see a doctor" is still prominent. The pressure from the government is increasing year by year, but the actual problems have not been completely solved. It is very important to analyze the running state of medical security system. Based on the key project of the National Natural Science Foundation of China, "the innovation of the intelligent medical management and health management driven by big data", this paper puts forward the idea of using efficiency to analyze the medical security system based on the needs of evaluating the operating state and problems of the medical security system. First of all, through the domestic and foreign achievements and literature research, combined with medical security system characteristics and efficiency theory to determine the research method of data envelopment analysis, and the current application of DEA in the field of medical security are summarized. It is found that there are many limitations in the current DEA basic model. Secondly, an improved DEA-Tobit two-stage model is proposed to analyze the efficiency of medical security system. That is, using DEA to analyze internal factors and introducing PanelData-Tobit model to external interpretation variables to determine the impact of panel data regression, in addition to the improvement and expansion of the basic DEA model. The variable model of non-oriented scale reward and the relative validity model excluding the current decision making unit are proposed. The Malmquist productivity index method is introduced to construct the evaluation model of the operational efficiency of the medical security system. Third, through the combination of literature analysis and statistical analysis, based on the concept of health production function to select input and output indicators, establish a set of medical security system operational efficiency evaluation index system; Finally, a total of 124 decision-making units in 31 provinces of China from 2011 to 2014 were selected for empirical analysis, and the efficiency results were used as explanatory variables to introduce economy, government, urbanization, aging, education level, employment situation. As an explanatory variable, this paper analyzes the correlation between the health care input and the explained variable, and puts forward the corresponding improvement strategies and suggestions on the medical security system of our country combined with the result of efficiency evaluation.
【学位授予单位】：北京交通大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1

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