Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.
Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
Front Public Health. 2024 Nov 12;12:1444840. doi: 10.3389/fpubh.2024.1444840. eCollection 2024.
China's national comprehensive medical reform (NCMR) is an important attempt in the reform of healthcare system, and quantitative evaluation of its effect is of great significance for continuously deepening medical reform, grasping the reform direction, and building a healthy China. Therefore, focusing on medical resources and medical burden, this study aims to systematically explore the policy effectiveness and the provincial heterogeneity of NCMR, as well as the potential influencing factors.
Utilizing the collected multi-period panel data of 31 provinces in mainland China in 2006-2021, we regarded the release of the two batches of pilot provinces in NCMR as a quasi-natural experiment and comprehensively adopted a Staggered difference-in-differences (DID) model and Synthetic Control Method (SCM), combined with word frequency statistics and grouping regression analysis.
NCMR can effectively increase the number of licensed physicians by 12.6% and reduce the medical expense for in-patients by 7.2% in the pilot provinces. Furthermore, the NCMR policy effect in different pilot provinces shows various characteristics, and only Jiangsu, Zhejiang, and Chongqing achieve both the growth of medical resources and the reduction of medical expenditure. Meanwhile, word frequency statistics are conducted based on related policy descriptions and news reports on the official websites, so as to summarize the specific policy means in the three provinces, and provide a reference for other provinces to practice the healthcare reforms. Besides, extensibility analysis shows that the effect of NCMR is affected by the population aging and health status. Groups with low degree of population aging (low-AG)/high population health status (high-HE) performed a more obvious reform effect.
This study provides beneficial policy implications for increasing medical resources, reducing medical burden, and promoting medical reform process.
中国的国家综合医疗改革（NCMR）是医疗体系改革的重要尝试，对其效果进行定量评估对于不断深化医疗改革、把握改革方向、建设健康中国具有重要意义。因此，本研究聚焦医疗资源和医疗负担，旨在系统探索 NCMR 的政策效果和省级异质性，以及潜在的影响因素。
利用中国大陆 31 个省份在 2006-2021 年期间的多期面板数据，我们将 NCMR 中两批试点省份的发布视为准自然实验，并综合采用了交错差分（DID）模型和合成控制法（SCM），结合词频统计和分组回归分析。
NCMR 可以有效提高试点省份的执业医师数量 12.6%，降低住院病人的医疗费用 7.2%。此外，NCMR 政策效果在不同试点省份呈现出不同的特点，只有江苏、浙江和重庆实现了医疗资源的增长和医疗费用的降低。同时，基于官方网站上的相关政策描述和新闻报道进行词频统计，总结了这三个省份的具体政策手段，为其他省份实施医改提供了参考。此外，扩展性分析表明，NCMR 的效果受到人口老龄化和健康状况的影响。人口老龄化程度低（低-AG）/人口健康状况高（高-HE）的群体表现出更明显的改革效果。
本研究为增加医疗资源、减轻医疗负担、推进医改进程提供了有益的政策启示。
