基于SD建模的老年人健康需求、医疗服务利用与医疗保障联动优化研究

With the rapid development of society, the aging of the population has gradually become a prominent problem in China's society. Under the current condition of entering into the aging society before it gets rich and we are not prepared for this challenge in China, government finance and health care system is facing a heavy burden, and the situation is getting serious. In the process of aging, health demands, health services utilization and medical insurance for the elderly have been concerned, but the point of view is single and not comprehensive enough. Especially, there have been few studies on the relations among health demands, health services utilization and medical insurance. In order to improve the utilizations of health service for the older people, to ensure the safe operation of the medical insurance fund, and to meet the health demands of the elderly, we analyze the influence factors on the health demands and health services utilization of the elderly in China. And the quantity relation of health demands, health services utilization and medical insurance is defined..In this study, research methods and theories include integrated theory of Grossman health demands model in human capital theory, Andersen behavior model of health services utilization, four-part model, modeling technique of system dynamics and actuarial principle for social insurance. Based on time series statistics and micro-data of elderly health services survey, the research describes the demand and utilization of medical services in the elderly and explores the possible factors that affect the health demands and health services utilization. The research focuses on the behavior characteristics of organizations in medical care system of the elderly, defines the influential factors and mechanism, analyzes the development tendency of health demands and utilization, proposes strategies for harmonious development of health care, and provides scientific basis for further health system reform. In the study, a quantitative decision and control framework is established, which can illustrate relationship and mechanism among the health demands, health services utilization and the balance of the basic medical insurance fund. The study summarizes several suggestions on how to keep the basic medical insurance fund in balance and satisfy health demands and health services utilization of the elderly. So as to provide a basis for the evidence-informed policy making in resolving medical insurance problems for the elderly people in the process of aging population in China. It is advantageous to guarantee the health demands of the elderly, improve the health of the elderly, and help realize the target of establishing a well-off society and constructing a harmonious socialist society.

在我国“未富先老”、“未备先老”快速老龄化的严峻形势下，老年人健康需求与医疗服务利用面临巨大挑战，医疗保障面临空前压力。针对现有研究局限于单一的老年人健康需求、医疗服务利用或医疗保障分析，未开展三者之间联动机制与优化研究，缺乏对指标动态变化预测和时间累积效应评估，我们在前期老年健康研究基础上，拟利用Grossman健康需求理论、Andersen服务利用模型、保险精算学、四部模型法等，应用系统动力学（SD）方法，了解老年人健康需求、医疗服务利用与医疗保障现况；分析其影响因素并建立老年人健康需求与医疗服务利用发展模型，预测未来变化趋势；分析老年人健康需求、医疗服务利用与医疗保障系统的量化联系，尤其综合考虑主客观健康需求与不同类型医保作用，明确联动机制；基于SD模型“政策实验室”特性干预仿真以筛选优化策略，提出应对人口老龄化完善医疗服务与医疗保障体系的思路与方案，为实施健康老龄化提供决策依据。

在我国快速人口老龄化进程下，基于老龄人口健康状况相比于其他年龄群体较差的客观事实，老年人健康需求与医疗服务利用面临巨大挑战，医疗保障面临空前压力。突破传统研究多局限于孤立的老年人健康需求或医疗服务利用、缺乏老年人健康需求指标动态变化预测和时间累积效果评估等技术瓶颈，本项目从系统动力视角研究老年人健康需求、医疗服务利用与医疗保障联动机制，包括利用老年人健康调查面板数据以及个体微观数据剖析了老年人健康需求、医疗服务利用与医疗保障联动策略在时间序列上的演化特征；定量论证了医疗保障对老年人健康收益与医疗服务利用的影响，阐明老年人多阶段就医决策行为驱动机制，尤其阐明贫困老年人就医障碍；测量医疗保障对老年人健康收益与医疗费用支出的影响，提出医保名义补偿率与老年人个人支出实际补偿比之间存在的差距及影响因素；运用系统动力学方法构建老年人医疗服务与医疗保障SD模型，模拟预测老年人健康需求与医疗服务利用的未来发展，并建立老年人健康需求、医疗服务利用和医疗保险参数之间的量化联系，分析老年人健康需求与医疗服务利用变化对于医疗保障系统的影响；所建立的老年人健康需求—医疗服务利用—医疗保障SD仿真模拟与干预平台，为老年医疗服务与医疗保障政策的制定提供循证研究工具；实现老年人口健康需求、医疗服务利用、医疗保障系统内部结构与行为特征的仿真干预，提出改善老年人健康需求与医疗服务利用策略，为我国积极应对人口老龄化、提升老龄人口健康水平提供理论与实证依据。