【正文】 畢業(yè) 論文 外文資料翻譯 題 目 合作醫(yī)療保 險(xiǎn)改革與中國(guó)農(nóng)村地區(qū) 鄉(xiāng)鎮(zhèn)衛(wèi)生院效率：從調(diào)查數(shù)據(jù)分析 學(xué) 院 經(jīng)濟(jì) 學(xué)院 專 業(yè) 經(jīng)濟(jì) 學(xué) 班 級(jí) 0901 學(xué) 生 王強(qiáng) 學(xué) 號(hào) 20202221328 指導(dǎo)教師 王雷 二〇一 三 年 四 月 十九 日 濟(jì)南大學(xué)畢業(yè) 論文外文資料翻譯 1 China Economic Review， 2020（ 4）： 1326. Health insurance reform and efficiency of township hospitals in rural China:An analysis from survey data Martine Audibert, Jacky Mathonnat, Aurore Pelissier, Xiao Xian Huang, Anning Ma ABSTRACT In the rural healthcare organization of China, township hospitals ensure the delivery of medical services above village health stations and below county hospitals. Particularly damaged by the economic reforms implemented from 1975 to the end of the 1990s, the efficiency of township hospitals has been questioned, mainly because of the implementation since 2020 of the reform of health insurance in rural areas (New Rural Cooperative Medical Scheme). From a database of 24 randomly selected township hospitals observed over the period 2020–2020 in Weifang Prefecture (Shandong), this study examines the efficiency of township hospitals through a twostage approach. As curative and preventive medical services delivered at township hospital level use different production processes, two data envelopment analysis models are estimated with different orientations to pute scores. The results show that technical efficiency has declined over factors explaining technical efficiency are mainly environmental characteristics rather than internal ones. Among these environmental factors, NRCMS have in average a negative effect on the evolution of THs efficiency, although efficiency have improved for some of results suggest also that, in the context of China, the efficiency of township hospitals is influenced by unobservable factors. From our findings, we suggest five main orientations to improve THs efficiency. In the rural Chinese healthcare system, township hospitals (THs) play an essential role: they represent the main providers of primary healthcare in rural areas (Hillier amp。 Shen, 1996). THs constitute the intermediate level of healthcare facilities and ensure the link between village health stations at the grassroots level and county or abovelevel hospitals. They supervise healthcare delivery at the level of village health stations, and act as gate keepers, orienting patients toward higher health facility levels. They offer a wideranging set of general medical services by delivering curative and preventive activities, from 濟(jì)南大學(xué)畢業(yè) 論文外文資料翻譯 2 vaccinations and laboratory tests to outpatient visits and inpatient care. The Chinese rural healthcare system has greatly changed since the 1950s. From 1950 to 1975, China achieved significant improvements in health outes, thanks to the definition of an efficient threetier system of healthcare delivery and a successful munitybased rural health insurance scheme (Hsiao, 1995。 World Bank, 1997). However, the economic transition (1975–1990) caused the deterioration of these two pillars of the rural healthcare system (Liu, Xu, amp。 Wang, 1996。 Wagstaff, Lindelow, Wang, amp。Zhang, 2020).1 First, the CooperativeMedical System(CMS) in 1975 quasiuniversal coverage was achieved in rural areas, less than 10% of the rural population was still insured in the 1990s (World Bank, 1997). Secondly, the threetier system, consisting of village health stations, township and county hospitals (from the lower level to the upper one), was disrupted. The efficiency of THs has declined due to the economic reforms (Hsiao, 1995。 Liu, Rao, amp。 Hu, 2020). The budget decentralization (1979)and the management reform of THs (1983) led them to look for profitable activities (Hillier amp。 Shen, 1996。 Liu et al., 1996). As a consequence, negative externalities came to light: the quality of healthcare declined, healthcare prices increased, expensive technologies were overused, drugs were overprescribed, the average length of stay increased and preventive activities were neglected to privilege expensive curative activities (Eggleston, Ling, Qingyue, Lindelow, amp。Wagstaff, 2020。 Hillier amp。 Shen, 1996。 Hsiao,1995。 World Bank, 1997). The collapse of the CMS disturbed the referral system. Moreover, as THs suffered from a bad reputation, patients bypassed them to go directly to county hospitals (World Bank, 1997). This phenomenon was enhanced by the increase of rural ines, leading patients to look for higher quality services and enhancing their capacity to pay for health (Liu et al., 1996). Thus,the activity of THs fell off. Since 2020, the implementation of the New Rural Cooperative Medical Scheme (NRCMS) has served mainly two first one is to offer an insurance system to the rural population, in order to lower the financial barrier to accessing the healthcare system and to improve the rural population39。s health (Wagstaff, Lindelow, Wang, amp。 Zhang, 2020). The second one is to make the THs, which suffered from the economic liberalization, more attractive by reorientating patients toward this level. The question of the THs39。 efficiency is crucial, with regard to their strategic position in the healthcare delivery chain and the changes they experienced over the preceding years, but also in a context of scarce resources, of vertical and horizontal petition and health insurance reform. By targeting THs more than other health facilities in Weifang Prefecture, on which this study is focused, the NRCMS can influence the activity and the efficiency of 濟(jì)南大學(xué)畢業(yè) 論文外文資料翻譯 3 these facilities. The main channels are the likely increase in demand induced by insurance and the implementation of contracts. Therefore, identifying the determinants of THs39。