医疗服务的公平与效率——基于医院运行效率的医保患者住院费用差异分析  

Fairness and Efficiency of Medical Services——An Analysis of Hospitalization Cost Differences for Basic Medical Insurance Patients Based on Hospital Operation Efficiency

作　　者：胡嘉靖 刘思佳 

机构地区：[1]内蒙古医科大学卫生管理学院,呼和浩特010100

出　　处：《中国医疗保险》2025年第2期91-97,共7页China Health Insurance

基　　金：内蒙古社会科学基金“公平与效率的权衡:双重标准下内蒙古医疗卫生资源配置的评价研究”(2024QY21);内蒙古医科大学面上项目“内蒙古自治区老年人疾病负担测算及影响因素研究”(YKD2023MS069)。

摘　　要：目的:探究医院运行效率对不同医疗保险类型患者的住院费用差异的影响,分析效率提升与住院费用公平性的关系。方法:收集内蒙古300家医院2020年的住院费用相关数据,采用数据包络分析测算医院运行效率。使用分层随机抽样选取22家医院,使用患者住院数据,通过线性回归模型分析住院费用与医院效率、医疗保险类型之间的关系。结果:2020年医院平均运行效率为0.4015,整体有效率为6.33%。医院运行效率每增加0.1,基本医保患者平均住院费用将增加2.39%,其中城乡居民医疗保险患者人均住院费用增幅相对较高,与职工医保患者的人均住院费用差距减少4.07%。结论:提高医院运行效率能够有效缩小不同医疗保险类型患者的住院费用差距,从而促进医疗费用的公平性提升。但公平性的改善伴随着城乡居民医疗保险患者住院费用的显著上涨,可能导致患者经济负担加重。建议加大对城乡居民的医疗保障力度,完善多层次医疗保障体系,优化医疗资源配置,并完善费用监管机制,以确保在提升医院效率的同时,维护患者的经济负担水平和医疗可及性。Objective:The paper explores the impact of hospital operation efficiency on the disparity in hospitalization costs among patients with different types of basic medical insurance,and analyzes the relationship between efficiency improvement and the equity of hospitalization costs.Methods:Data were collected from 300hospitals in Inner Mongolia in 2020,and data envelopment analysis was employed to measure hospital operation efficiency.A stratified random sampling method was used to select 22 hospitals.Patient hospitalization data were analyzed with a linear regression model to explore the relationship between hospitalization costs,hospital efficiency,and types of medical insurance.Results:The average operation efficiency of hospitals in 2020 was 0.4015,with an overall effective rate of 6.33%.For every increase of 0.1 in hospital operation efficiency,the average hospitalization cost of basic medical insurance patients will increase by 2.39%.The per capita hospitalization cost of urban and rural residents' medical insurance patients increase relatively higher,and the gap between the per capita hospitalization cost of urban and rural residents' medical insurance patients and employees' medical insurance patients decrease by 4.07%.Conclusion:Enhancing hospital operation efficiency can effectively narrow the gap in hospitalization costs between patients with different types of basic medical insurance,thereby promoting the equity of medical expenses.However,this improvement in equity is accompanied by a significant increase in hospitalization costs for residents,which may lead to an increased economic burden.It is recommended to strengthen the security of urban and rural residents' medical insurance,refine the multi-level healthcare security system,optimize the allocation of medical resources,and improve the cost supervision mechanism to ensure that the enhancement of hospital efficiency does not affect patients' economic burdens and access to medical care.

关 键 词：医院效率 住院费用 医保类型 医疗公平性 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]