我国多层次医疗保障水平及其时空分异  

The level and spatiotemporal differentiation of multi-level medical security in China

作　　者：陈浩斌 王泽嘉毓 萧绮俐 舒燕 原彰 CHEN Hao-bin;WANG Ze-jia-yu;XIAO Qi-li;SHU Yan;YUAN Zhang(The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510006,China;不详)

机构地区：[1]广州中医药大学第八临床医学院,广东广州510006 [2]西南财经大学公共管理学院 [3]广州中医药大学第二临床医学院 [4]广州中医药大学公共卫生与管理学院,广东广州510006

出　　处：《现代预防医学》2024年第19期3563-3569,共7页Modern Preventive Medicine

基　　金：广州市哲学社会科学发展十四五规划2023年度共建课题(2023GZGJ200);2022年广东省教育科学规划课题项目(2022GXJK061);2022年广东省哲学社科规划课题项目(GD22XGL51)。

摘　　要：目的 测算我国多层次医疗保障水平综合指数,分析多层次医疗保障水平时空分异,为推动多层次医疗保障体系发展提供参考。方法 基于2011-2020年数据,利用AHP法和熵值法测算我国多层次医疗保障水平综合指数,利用Dagum基尼系数及其分解方法分析时空演化特征及差异来源。结果 综合指数排名前十的地区保障能力优势不同,综合指数后十位大多数地区不具有高基本医疗保险评价指数,多层次医疗保障水平并非与经济发展水平呈单纯的正相关或负相关关系;多层次医疗保障水平总体基尼系数呈“先升后降”的变化趋势,区域内和区域间基尼系数整体呈下降趋势;组内贡献率波动幅度缓和,组间贡献率和超变密度贡献率呈“镜像”对称演变趋势。结论 发挥基本医疗保险主体作用,加强各层次医疗保障衔接;发挥区域医疗保障资源优势,补充区域医疗保障能力短板;持续增强多层次医疗保障公平性,缩小区域间医疗保障水平差异。Objective To calculate the comprehensive index of multi-level medical security in China and analyze its spa-tiotemporal differentiation,providing references for the development of a multi-level medical security system.Methods Based on data from 2011 to 2020,the Analytic Hierarchy Process(AHP)and entropy method were used to calculate the comprehen-sive index of multi-level medical security in China.The Degum Gini coefficient and its decomposition method were utilized to analyze the characteristics of spatiotemporal evolution and sources of differences.Results The regions ranked in the top ten for the comprehensive index exhibited varying advantages in security capacity,while most regions in the bottom ten lacked a high basic medical insurance evaluation index.The level of multi-level medical security did not simply correlate positively or negatively with economic development.The overall Gini coefficient for multi-level medical security showed a trend of"rising at first and then falling",with both intra-regional and inter-regional Gini coefficients generally declining.The fluctuation range of intra-group contribution rates softened,while inter-group contribution rates and super variance den-sity contribution rates exhibited a"mirror"symmetrical evolution trend.Conclusion It is suggested to strengthen the primary role of basic medical insurance and enhance the coordination among various levels of medical security,leverage regional medical security resource advantages to address shortcomings in regional medical security capacity,and continuously improve the equity of multi-level medical security to narrow the disparities in medical security levels between regions.

关 键 词：多层次医疗保障体系 AHP法 熵值法 Dagum基尼系数 

分 类 号：R197.1[医药卫生—卫生事业管理]