Qiu Zenghui, Fu Meiling, Liu Lanfang, Yao Lan, Yin Shanshan, Chen Wen, Huang Jingjing, Jin Jiahui
The School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 40030, China.
Shenzhen Health Development Research and Data Management Center, Shenzhen, 518028, China.
Sci Rep. 2025 Apr 22;15(1):13936. doi: 10.1038/s41598-025-96922-7.
Examined the synergistic development and spatio-temporal evolution of China's multi-level medical insurance system (MMIS) on a macroscopic level. We assess the comprehensive development of the MMIS across China's 31 provinces from 2011 to 2020 by constructing a comprehensive indicators evaluation model. Subsequently, a coupling coordination index (CCI) model is employed to provide precise insights into the coupling coordination effects among various medical insurance schemes comprising MMIS. Lastly, spatial autocorrelation analysis is conducted to evaluate both the global and local spatio-temporal evolutionary characteristics of MMIS. The CCI of MMIS at the national average level exhibited a fluctuating upward trend, progressing from the moderate disorder recession degree (0.287) in 2011 to the well-coordinated degree (0.887) in 2020. However, the majority of provinces (83.87%) still lingered within the realm of barely coordinated degree ([0.500-0.600]). Specifically, the CCI within the eastern coastal region surpassed that of the western and central regions, with the central region showing the most pronounced increase in CCI. Over the past decade, MMIS demonstrated significant spatial agglomeration, as evidenced by the global Moran's I ranging from [0.1668-0.3037]. Furthermore, findings from local spatial autocorrelation analysis suggest a gradual attenuation in the spatial clustering disparity of CCI across various provinces. Government ought to focus on the spatio-temporal evolution patterns of MMIS, and strengthen cooperation between the government and market in health governance, while utilizing information technology and data sharing to improve the overall quality of medical insurance benefits.
从宏观层面考察了中国多层次医疗保险体系（MMIS）的协同发展及时空演变。我们通过构建综合指标评价模型，评估了2011年至2020年中国31个省份MMIS的综合发展情况。随后，采用耦合协调指数（CCI）模型，以精确洞察构成MMIS的各种医疗保险计划之间的耦合协调效应。最后，进行空间自相关分析，以评估MMIS的全球和局部时空演变特征。MMIS的全国平均水平CCI呈波动上升趋势，从2011年的中度失调衰退程度（0.287）发展到2020年的良好协调程度（0.887）。然而，大多数省份（83.87%）仍徘徊在勉强协调程度（[0.500 - 0.600]）范围内。具体而言，东部沿海地区的CCI超过了西部和中部地区，中部地区的CCI增长最为显著。在过去十年中，MMIS表现出显著的空间集聚，全球莫兰指数（Moran's I）范围为[0.1668 - 0.3037]。此外，局部空间自相关分析结果表明，各省份CCI的空间聚类差异逐渐减弱。政府应关注MMIS的时空演变模式，加强政府与市场在卫生治理方面的合作，同时利用信息技术和数据共享来提高医疗保险福利的整体质量。
