新医改前后新型农村合作医疗基金生产率变化研究

Research on New Rural Cooperative Fund Productivity Changes before and after New Medical Reform

目的:研究新医改前后,山东省某市7个县新型农村合作医疗基金的生产率变化。方法:选取年参合人数、年筹资总额指标作为投入指标,选取各级医疗机构补偿总人次和补偿总额作为产出指标。利用Excel 2010建立数据库,使用DEAP2.1软件,分析7个县市的新型农村合作医疗基金全要素生产率变化、技术效率变化和技术进步变化。结果:在新医改后,新型农村合作医疗基金的全要素生产率呈降低趋势(tfpch改革前=1.314,tfpch改革后=1.103,t=3.533,P=0.006);新型农村合作医疗基金的技术效率变化不明显(effch改革前=1.037,effch改革后=1.001,t=1.560,P=0.085);新型农村合作医疗基金的技术进步显著降低(tech改革前=1.278,tech改革后=1.112,t=4.856,P=0.001);结论:山东省某市7个县新型农村合作医疗基金在新医改前后生产率变化明显,诸多新医改政策的层叠效应有效抑制了医疗服务供需双方的行为,不断攀升的次均住院补偿费用影响了基金的受益面,从而影响了新型农村合作医疗基金的使用效率。

Objective： To study the productivity change of New Rural Cooperative Medical System（NCMS） fund in 7 counties of a city in Shandong before and after new medical reform. Methods： Annual participating number and annual financing amount index were selected as the input index. Total compensation person-time for different-tier medical institutions and total compensation amount were selected as the production index. Using Excel 2010 to establish a database, DEAP2.1 was used to analyze the total factor productivity change, technical efficiency change and technological change of NCMS fund in 7 counties and cities. Results： After the new medical reform, TFP fund average value showed decreasing trend（tfpchbefore reform=1.314, tfpchafter reform=1.103, t= 3.533, p=0.006）; technical efficiency of NCMS fund average values decreased significantly（techbefore reform =1.278, techafter reform=l.112, t=4.856, p=0.001）. Conclusion： In 7 counties of a city in Shandong, NCMS fund in the new medical reform and productivity change obviously, cascading effect many new medical reform policies to restrain the behavior of both the supply and the demand for medical services so as to effect the efficiency in the use of NCMS fund.