Research On The Influence Of Income Gap And Medical Insurance System Segmentation On The Efficiency Of Health Care System

Along with the development of China's economy and the improvement of income level,the residents' preferences for healthy life and the requirements of medical security level are constantly improving,and the medical health system and its efficiency are facing new challenges.Income level and medical insurance promote the increase of the right to seek medical treatment,high-income people's minor illness crowd out the medical resources of large-scale comprehensive hospitals,low-income people's major illness is difficult to get close to high-quality medical resources,resulting in the virtual hierarchical diagnosis and treatment system,and the serious shortage of resources of large-scale comprehensive hospitals coexist with the waste of resources of small community hospitals.Although the operation efficiency of large general hospitals is very high,the medical and health system is in a low efficiency state.This paper discusses the impact of income gap and medical insurance system segmentation on the efficiency of medical and health system.The mechanism of income gap affecting the efficiency of health care system: simple diseases of high-income people occupy high-level medical services(over medical treatment)-serious diseases of low-income people are difficult to be fully treated(insufficient medical treatment)-medical resource allocation is unreasonable-the efficiency of health care system is reduced.The division of medical insurance system(employee medical insurance and resident medical insurance)intensifies the impact of income gap on the efficiency of medical health system.High income people participate in a higher level of medical security system,and are more willing to spend more medical resources for simple diseases.To this end,this paper takes the efficiency of the medical and health system in the 13 administrative districts of Wuhan from 2011 to 2016 as the research object,and builds the DEA-Tobit two-stage model based on the theory of the comprehensive medical insurance system.Firstly,by introducing the indexes of patients' satisfaction degree in the diagnosis and treatment process,effect satisfaction degree and expert score of diagnosis and treatment scheme,the improved DEA model is constructed to compare and analyze the technical efficiency,scale efficiency and comprehensive technical efficiency of the medical and health system in each administrative region of Wuhan.Secondly,we use Malmquist model to analyze the time trend and regional differences of the efficiency of health care system.Finally,taking the comprehensive technical efficiency value of DEA improvement model as the explanatory variable,the income gap between different medical insurance groups and medical insurance system segmentation as the explanatory variable,and the per capita GDP et al.as the control variable,the Tobit regression model is established to analyze the influencing factors of the efficiency of medical health system.Conclusion:1.According to the economic development,the efficiency of the medical and health system in each administrative region of Wuhan presents a "U-shaped" structure,that is,the efficiency of the medical and health system from low to high is in the order of the lowest in the middle developed administrative region,the middle in the lower developed administrative region,and the highest in the higher developed administrative region.Among them,the technical efficiency of the more developed administrative regions is better and stable,but the scale efficiency is relatively low.The technical efficiency of the medium-sized administrative regions in economic development is high but fluctuates greatly,while the scale efficiency of the underdeveloped administrative regions is the lowest but fluctuates little.This shows that the level of economic development plays an important role in improving the efficiency of the health care system in general,but the speed of improving the efficiency of the health insurance system based on economic development lags behind the speed of economic development in general.2.Income gap and division of medical insurance system have significant and steady negative impact on the efficiency of medical and health system.First,the income gap has a negative impact on the efficiency of the health care system.In areas with large income gap,the efficiency of health care system is generally low.(regression coefficient =-2.303,t =-3.81,P < 0.01);secondly,the segmentation of medical insurance system has a significant negative impact on the efficiency of medical health system(regression coefficient = 2.625,the explanatory variable in the model is the reverse index of the segmentation degree of medical insurance system,t = 4.38,P < 0.01).3.Since the implementation of the integration of urban and rural medical insurance system in 2015,the efficiency of the medical and health system in each administrative region has been comprehensively improved in 2016 compared with that before the integration,but the relative efficiency ranking of each region has not changed.Policy implication: to design the medical insurance system,we should give the low-income people a higher level of security in order to alleviate the negative impact of the income gap and improve the efficiency of the medical and health system;to further integrate the medical insurance of urban employees and residents,improve the payment audit mechanism of medical insurance,and incorporate the quality of medical services into the assessment index system;to change the way of expanding medical insurance in order to avoid the overuse of high-quality medical resources,reduce the cost of medical security and improve the efficiency of the medical and health service system.