中国卫生事业管理2025，Vol.42Issue(10)：1119-1125,7.
社会结构因素影响下基本医疗保险覆盖变化机制的系统动力学分析
System Dynamics Analysis of The Change Mechanism of Basic Medical Insurance Coverage Influenced by Social Structural Factors
摘要
Abstract
Objective To construct a system model incorporating three major social structural factors of economic conditions,employment market and demographic structure based on system dynamics theory,analyze the structural linkage mechanism of changes in China's basic medical insurance coverage level,and identify key feedback paths and time lag characteristics in institu-tional regulation.Methods National statistical data from 2011 to 2023 were collected to construct an indicator system encompassing three types of structural factors.Utilizing Vensim PLE,the causality diagrams and system flow diagrams were plotted,and a dy-namic evolution model for medical insurance coverage was established.Through simulation feedback mechanism,sensitivity analy-sis and delayed response mechanism,the key regulatory factors and system behavior characteristics were identified.Results The model exhibits a high degree of historical fit and good structural stability.Simulation results indicated that medical insurance cov-erage demonstrated strong responsiveness to changes in economic conditions and employment market variables.Under the delay mechanism,the lag effects of variables such as institutional supply capacity,economic vitality and innovation,and employment situation were significant.The longer the delay,the more gradual the trend of medical insurance coverage improvement becomes.Conclusion The current level of medical insurance coverage is undergoing a structural change driven by the expansion of employees and contraction of residents.The institutional response intensity of different social structural factors is significantly uneven,and the policy adjustment effect lags behind,which reflects that the medical insurance system still lacks targeted adjustment mechanisms and rhythm control capabilities facing structural changes such as population aging and diversified employment forms.To achieve long-term sustainable development of the system,it is urgent to enhance the coverage and adaptability for the informal employ-ment group,improve the sensitivity identification and feedback prediction ability of the system to key structural variables,and pro-mote cross system coordination of medical insurance expansion,fiscal regulation,and employment policies to improve the dynamic stability and fair protection level of medical insurance system in the complex social structures.关键词
医保覆盖/经济状况/就业市场/人口结构Key words
medical insurance coverage/economic conditions/employment market/demographic structure分类
医药卫生引用本文复制引用
宋乐,单凌寒,侯文萍,祝成,卫艳茹..社会结构因素影响下基本医疗保险覆盖变化机制的系统动力学分析[J].中国卫生事业管理,2025,42(10):1119-1125,7.基金项目
国家自然科学基金项目"融合视角下的基本医疗保险未参保人群识别、多维机制探索与协同治理策略研究"(72474061) （72474061）
国家自然科学基金项目"基于参保者受益导向的多视角医保协同问题诊断与成因分析"(71804036) （71804036）
黑龙江省普通本科高等学校青年创新人才培养计划项目"多元需求下参保者医保利用偏好与行为的问题与机制研究"(UNPYSCT-2020176) （UNPYSCT-2020176）
黑龙江省公共健康安全及医改策略研究高端智库项目"中国式现代化背景下公众医保政策素养的提升策略研究"(ZKKF2022088) （ZKKF2022088）
