人口结构影响医疗费用增长的定性比较分析

A Qualitative Comparative Analysis of the Impact of Population Structure on the Growth of Medical Expenses

如何控制医疗卫生费用的非合理性增长,对“健康中国2030”规划建设具有战略意义。已有研究侧重于老龄化、城镇化、收入水平等人口结构因素以及医疗服务需求、医疗技术进步等因素的“净效应”,即控制其他变量之后的平均效应量。而定性比较分析通过研究这些因素的“组态效应”,探讨它们影响高医疗费用的必要性和充分性。研究发现,引致高医疗费用的条件组态主要有三个,可将其归为两类模式,即城镇化推动型和医疗技术推动型;而人口老龄化在三个路径中仅发挥辅助性作用。这意味着,各地要根据其城镇化水平、医疗技术及医疗资源供给、医疗保障水平等选择不同的治理路径。

How to control the unrensonable increase of medical and health expenses is of strategic significance to the construction of the“Health China 2030”.The previous research works have focused on the“net effect”of factors such as aging,urbanization,income level,medical service demand and technological progress,which is the average effect size after controlling for other variables.But qualitative comparative analysis explores the necessity and adequacy of their influence on high medical expenses by studying the“configuration effect”of these factors.We find that there were three configurations to lead high medical expenses,which could be classified into two types of the urbanization and medical technology,while the aging only played an auxiliary role in the three paths.It indicates that each region of China should choose different governance paths according to its urbanization level,medical technology and medical resource supply,medical security level.