[1]邹嘉诚,戴 桪,刘彦琛,等.城镇职工基本医疗保险运行效率及提升路径研究 ——基于DEA-Malmquist和fsQCA方法[J].卫生经济研究,2026,43(07):46-51.
　ZOU Jiacheng,DAI Yue,LIU Yanchen,et al.Study on the Operational Efficiency and Improvement Pathways of Urban Employee Basic Medical Insurance in China ——Based on the DEA-Malmquist and fsQCA Methods[J].Journal Press of Health Economics Research,2026,43(07):46-51.
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城镇职工基本医疗保险运行效率及提升路径研究
——基于DEA-Malmquist和fsQCA方法

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
43
期数:
2026年07期
页码:
46-51
栏目:
医疗保障
出版日期:
2026-07-03

文章信息/Info

Title:
Study on the Operational Efficiency and Improvement Pathways of Urban Employee Basic Medical Insurance in China
——Based on the DEA-Malmquist and fsQCA Methods
作者:
邹嘉诚1; 2; 戴 桪1; 刘彦琛1; 陈剑函3; 李绍华2; 4
1.东南大学公共卫生学院，江苏 南京 210009
2.安徽医科大学卫生管理学院，安徽 合肥 230032
3.安徽医科大学第一附属医院，安徽 合肥 230022
4.安徽省医疗保障研究院，安徽 合肥 230032
Author(s):
ZOU Jiacheng;  DAI Yue;  LIU Yanchen;  CHEN Jianhan;  LI Shaohua
School of Public Health, Southeast University, Nanjing Jiangsu 210009, China
关键词:
城镇职工基本医疗保险; DEA-Malmquist; fsQCA; 运行效率
Keywords:
urban employee basic medical insurance;  DEA-Malmquist;  fsQCA;  operational efficiency
分类号:
R19
文献标志码:
A
摘要:
目的：分析我国职工医保运行效率，为医保制度优化和政策改进提供参考。方法：通过DEA-Malmquist方法测算2020—2023年我国职工医保运行效率，运用fsQCA方法探索提升效率的多重路径。结果：我国职工医保运行效率综合水平整体偏低，2022年出现断崖式下降，主要由规模效率下降所致；纯技术效率总体保持较高水平；全要素生产率总体提升，但在技术进步回落阶段，规模效率反弹成为主要制约因素；各省职工医保运行效率差异显著，高效率不存在单一充分或必要条件。结论：可通过统筹提级与再保险协同、支付监管一体化改革，以及分型治理，推动医保制度优化和政策改进，因地制宜持续提升职工医保运行效率。
Abstract:
Objective To analyze the static and dynamic operational efficiency of employee medical insurance system in China, and to provide references for optimizing the medical insurance system and improving policies. Methods The DEA-Malmquist method was used to measure the operational efficiency of employee medical insurance system from 2020 to 2023, and the fsQCA method was applied to explore multiple pathways for improving efficiency. Results The overall comprehensive operational efficiency of employee medical insurance system in China remained relatively low, with a cliff-like drop in 2022 primarily driven by a decrease in scale efficiency. The pure technical efficiency generally remained at a high level. The total factor productivity improved generally, whereas the rebound in scale efficiency emerging as the principal constraint during periods of diminishing technological progress. The significant differences in the operational efficiency of employee medical insurance were observed across provinces, and there were no single sufficient or necessary conditions for high efficiency. Conclusion It is necessary to elevate unified management, coordinate reinsurance, integrate the reforms of payment and supervision, and implement differentiated governance, so as to promote the optimization of the medical insurance system and policy improvements, and continuously enhance the operational efficiency of employee medical insurance in accordance with local conditions.

参考文献/References:

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更新日期/Last Update: 2026-07-03