Research On The Operational Efficiency Of The New Rural Cooperative Medical Insurance System And Its Associated Factors In Guangxi China

Objective:To estimate the operational efficiency of the New Rural Cooperative Medical System in Guangxi from 2010 to 2016,analyzing the influence of economy,health,compensation ratio and other factors on the efficiency of new rural cooperative medical insurance of the operation efficiency,and providing decision-making reference for urban and rural basic medical insurance system.Methods: This study used the data of the new rural cooperative medical insurance system of 74 counties(cities)and statistical yearbooks in Guangxi province from 2010 to 2016.The three-stage DEA model and three-stage Malmquist model were adopted to evaluate the operational efficiency of the new rural cooperative medical insurance in both the static and dynamic perspectives,respectively.In addition,the system GMM dynamic panel model and the panel threshold model were used to analyze the associated factors and threshold effect of the associated factors of the new rural cooperative medical insurance system.Results:1.By the end of 2016,the number of new rural cooperative medicalinsurance system participants in Guangxi was 32,400.9 thousand,the system has achieved basic coverage,the nominal per capita financing was 540 yuan and the actual per capita financing was 573.38 yuan.From 2010 to 2016,a rapid increasing was shown in the actual input and other indicators of the new rural cooperative medical system,and the Number of inpatient reimbursements and the amount of compensation increased year by year.2.The effect of the level of region economic development and medical service for the input variable of new rural cooperative medical insurance system is significantly,the mean value of the technical efficiency,pure technical efficiency and scale efficiency is 0.894,0.924 and 0.967 from 2010 to 2016,the technical efficiency is mainly affected by the scale efficiency,70% of the county(city)is still room to improve efficiency;From 2011 to 2016,the technical efficiency variation index,the pure technical efficiency variation index and the scale efficiency variation index of the new rural cooperative medical insurance increased by 0.7%,0.5% and 0.2% respectively,the total factor productivity decreased by 28.8%.Technical retrogression is the main reason for the declining in operational efficiency.3.There are first-order and second-order hysteresis effects on the operational efficiency of the new rural cooperative medical insurance system.The number of medical technical personnel,rate of fund utilization,actual reimbursement ratio of hospitalization in the county and per capita hospitalization expenses play a significant role in promoting the operating efficiency of the new rural cooperative medical insurance system.The number of beds,per capita net income of farmers,per capita financial input and the reciprocal rate of infant and child mortality have significant inhibitory effects on the efficiency of new rural cooperative medical insurance system.4.The rate of fund utilization has a single threshold effect on the efficiency of the new rural cooperative medical system.When the per capita hospitalization cost is less than5560 yuan,the fund utilization rate plays a greater role in promoting the efficiency of the new rural cooperative medical system.When the per capita hospitalization cost rises to the threshold value,the fund utilization rate plays a weaker role in promoting the efficiency.Conclusions: The new rural cooperative medical insurance system is in good condition in Guangxi,the level of investment is improving,but the efficiency of fund used was lower than expected.The operating efficiency of the new rural cooperative medical insurance in some districts and cities was low,and the management efficiency and medical treatment efficiency have decreased.it is necessary to expand the scope of disease compensation,increasing the proportion of inpatients' compensation within the county,and enhancing the input of medical and health resources in economically strong counties and large medical counties.