基于DEA模型的我国职工医保公平性与效率研究  

Analysis of the equity and efficiency of the employee medical insurance in China based on the data envelopment analysis model

作　　者：王佳玮 徐俊芳 Wang Jiawei;Xu Junfang(School of Public Health,Zhejiang University,Department of Pharmacy,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310058,Zhejiang Province,China)

机构地区：[1]浙江大学公共卫生学院,浙江大学医学院附属第二医院药学部,杭州310058

出　　处：《中国医疗管理科学》2025年第2期21-28,共8页Chinese Journal Of Medical Management Sciences

基　　金：浙江省医疗保障局项目“推动共富型医疗保障制度融合发展研究标项二:医保共济保障机制可持续路径研究”。

摘　　要：目的分析我国城镇职工医疗保险的公平性和运行效率,为进一步优化职工医保基金资源配置提出政策建议。方法选取2018年—2022年职工医保基金省级面板数据,采用描述性统计方法、DEA模型和Malmquist指数模型等测算基金的公平性和运行效率。结果职工医保基金存在区域间不平衡现象,同一年份基金结余差距最高可达6690961万元,且并无减缓趋势。基金区域间不平衡现状与区域经济发展水平、劳动力数量、人口老龄化程度等因素有关。2018年—2022年我国职工医保基金运行综合效率均值为0.582,大部分地区基金运行处于相对无效状态。5年间,基金运行总体效率虽有上升趋势,但提升幅度较小,效率仍然不高。结论我国职工医保基金的公平性和运行效率均有待提高。政府应进一步提高医保统筹层次,建立基金调剂机制,不断提高基金管理水平和运行效率。Objective To analyze the equity and operational efficiency of the urban employee medical insurance in China,thus proposing policy recommendations for further optimization of the allocation of medical insurance fund resources.Methods Based on the panel data of provincial-level medical insurance funds from 2018 to 2022,descriptive statistical methods,data envelopment analysis(DEA)models,and Malmquist index models were employed to assess the equity and efficiency of urban employee medical insurance in China.Results There was a significant regional imbalance in the employee medical insurance funds.Within the same year,the fund surplus difference reached 66909.61 million yuan and even lacked a decreasing trend.This regional imbalance was closely related to regional economic levels,labor force size,and population aging.From 2018 to 2022,the average comprehensive efficiency of the employee medical insurance funds in China was 0.582,showing a relatively inefficient state in most regions.Over the five-year period,the overall efficiency of fund operations showed an upward trend,although limited by a minimal improvement and low efficiency value.Conclusion Both the equity and operational efficiency of the employee medical insurance funds in China require an improvement.The government should further enhance the level of insurance coordination,establish a fund adjustment mechanism,and continuously improve the fund management level and operational efficiency.

关 键 词：职工医保 公平性 效率 数据包络分析法 

分 类 号：R197.1[医药卫生—卫生事业管理]