【作者】 李俊；

【导师】 乐虹；

【作者基本信息】 华中科技大学 ， 医院管理， 2017， 硕士

【摘要】 【目的】描述分析我国人口政策变化、人口变迁以及医疗保险的发展历程,研究人口数量、结构等方面对医疗保险的影响程度,全面概括总结我国人口变迁过程,及我国医疗保险制度的发展历程,用统计学方法衡量人口变量对医疗保障水平和基金的关联度,从而构建我国医疗保障水平与人口发展的相关性模型。【方法】(1)文献研究:通过收集、整理国内外关于人口变化对医疗保险的影响的理论文献和数据资料,梳理归纳了人口因素对医疗保险系统的具体影响方式,研究其所用的理论与方法,评述其优势与不足,为本研究提供理论支持与技术支撑。(2)因子分析法:以动态过程的量化分析为主线,分析人口变量与医疗保障水平的相关性。(3)面板数据回归分析法:对相关面板数据以动态过程的量化分析为主线,衡量人口变量对医疗保险基金的关联度,以医疗保险基金为自变量分析它们之间的线性关系。(4)专家咨询法:通过座谈会帮助确定本研究涉及的人口及医保指标及指标体系,并对预期研究结果的指导性等方面进行论证。【结果】1.全国及湖北省人口及医保发展概况:根据国家人口政策的变化,将1949年-2014年分为7个阶段,从人口数量、增长率、出生率、死亡率、人口年龄结构、性别结构、人口老龄化、人口预期寿命、城镇化、人口素质等面板数据进行动态分析发现:人口政策变化影响着人口数量以及人口结构变化。1959-1961、1991-2014实施计划生育的阶段,人口增长率都小于1%,而其他阶段都在1%以上。分析我国31个统筹地区2003-2015年的城镇职工医保相关数据得知:参保率逐年上升,而医保基金支出增幅大部分年份大于基金收入增幅,医保基金面临穿底的风险。2.人口因素与医疗保障水平的实证研究结果:将影响医疗保险保障水平的人口学因素和医疗保险自身的因素一共15个指标缩减为五个因素:H1基金水平因素,贡献率为26%;H2医疗保险覆盖层次因素,贡献率为24%;H3人口政策因素,贡献率为13.3%;H4人口结构因素,贡献率为13%;H4人口素质因素,贡献率为10.6%。五个主成分因子的累计贡献率为87%,表明这五个主成分能解释医疗保险保障水平87%的影响因素发生的作用。3.人口因素与医保基金支出的实证研究结果:面板数据回归模型的调整R~2的值是0.8487,说明用面板数据回归这个模型的拟合程度较高,该模型包含的自变量的信息大概能解释各统筹地区医疗保险基金支出金额信息量的84.87%。参保率、在职退休比、人口死亡率、城镇化率、老龄化、性别结构、教育程度和医疗技术水平,这十个自变量对应的P值均小于0.001,说明纳入面板数据回归模型的自变量有因变量的影响有显著的统计学意义。老龄化这一自变量的回归系数是所有回归系数绝对值最大,说明老龄化对医疗保险基金支出的影响力最大,其次是城镇化、性别结构、人口死亡率、人口受教育程度、在职退休比、医疗技术水平、参保率、出生率、增长率。【结论】人口的出生率、死亡率、增长率、性别比、城镇化、教育水平、孕产妇死亡率(医疗技术水平)等方面不仅对医疗保障水平产生影响,还影响着医疗保险基金的平衡能力。经过系统的研究发现,我们所考虑的各个因素的影响力并不是单独存在的,影响医疗保险保障水平和基金平衡力的各因素之间还存在相互的影响作用,经济发展促进医疗技术进步,是人口老龄化的诱因,而人口老龄化对慢性病的治疗和疾病谱的变化的影响是实际存在的,人口发展作为影响医疗保险保障水平和基金平衡力的长期的主要的影响因素,它对医疗保险基金的筹资和医疗保险基金的补偿都产生不同程度的影响。不可测量的医疗诱导需求、道德风险和信息信息的不对称严重影响医疗保险基金的管理效率。更多还原

【Abstract】 [Purpose]Starting from the trend of population development of national medical insurance system and policy change analysis in China’s national medical insurance system development based on the history,the influence degree of population quantity and structure of medical insurance,the basic framework of the system,summarizes and comments on the characteristics and development of the universal health care system reform trend,using statistical methods to measure the population variable correlation to the level of medical security and fund,so as to construct the correlation model of China’s medical security level and population development.[Methods](1)Through the collection at home and abroad on the impact of demographic change on medical insurance theories and data,summed up the population specific factors on medical insurance system,research on the theory and method of its use,discusses its advantages and disadvantages,and provide theoretical support and technical support for this study;(2)Using factor analysis in order to quantify the dynamic analysis of the process as the main line,correlation analysis between population variables and medical security level;(3)the use of panel data regression analysis to quantify the dynamic analysis of the process as the main line,to measure the demographic variables correlation to the medical insurance fund,the medical insurance fund as the independent analysis of linear relationship between them;(4)through the organization experts,study involves the construction of a reasonable research index.The index system,the selection of statistical methods in line with the study,evaluation of the feasibility of research methods,and the guidance of the results of the study is expected to demonstrate.[Results]1.Overview of population and medical insurance development in China and Hubei:According to the change of the national population policy,the 1949-2014 is divided into 7 stages,from the population,growth rate,birth rate,mortality rate,population age structure,sex structure,the aging of the population,life expectancy,urbanization,population quality and dynamic panel data analysis showed that the population change and population policy closely related.1959-1961,1991-2014 implementation of family planning stage,the population growth rate is less than 1%,while the other stages are more than 1%.Analysis of 2003-2015 years of employee health insurance data that:the insured rate increased year by year,while the increase in the cost of medical insurance fund is greater than the majority of the fund’s income growth in the past year,the health insurance fund is facing the risk of wear.2.Empirical Study on the relationship between population and health care:According to the results of factor analysis,this study will influence the level of insurance coverage of medical and demographic factors and medical insurance own cut a total of 15 indexes to five factors:factor H1 fund level,the contribution rate was 26%;H2 medical insurance coverage level factors,the contribution rate was 24%;H3 population policy factors,the contribution rate was 13.3%H4;population structure factors,the contribution rate was 13%;H4 population quality factors,the contribution rate was 10.6%.The cumulative contribution rate of the five principal component factors was 87%,which indicated that these five factors could explain the effect of the influence factors of the medical insurance level of 87%.3.Empirical study on the relationship between demographic factors and medical insurance fund expenditure:The 0.8487 is to adjust the R~2 value of the panel data regression,regression model with panel data shows that the fitting degree is high,the model contains information about the variables can explain the medical insurance fund expenditure Co ordinating the various amount of information quantity is 84.87%.The rate of insurance,retirement job ratio,mortality,rate of urbanization,population aging,gender structure,education level and the level of medical technology,the ten variables of the corresponding P value was 0,indicating a panel data regression model selected independent variables of expenditure on medical insurance fund is a significant influence.The regression coefficients of the independent variables of the aging population is 0.82,it is all the regression coefficients of the absolute value of the maximum,indicating the aging of medical insurance fund influence,followed by urbanization,population structure,population mortality,sex education,in-service retirement ratio,medical technology level,insurance rate,birth rate,growth the rate of.[Conclusions]The development of population and policy changes affect the development of medical insurance.The birth rate,mortality rate,growth rate,sex ratio,urbanization,education level,maternal mortality(Medical Technology)etc.not only influence the level of medical care,but also affects the balance of medical insurance fund.After the research found that the factors we consider the influence of did not exist alone,interactions between various influence factors of medical insurance and fund balance,economic development to promote the progress of medical technology,is the cause of population aging,and the effect of aging treatment and changes of disease chronic disease spectrum is the actual existence,population development as influencing factors of medical insurance and fund balance long main influence,it to the medical insurance fund financing and health insurance fund compensation have different degrees of impact.The asymmetry of medical induced demand,moral hazard and information asymmetry can seriously affect the efficiency of medical insurance fund management.更多还原