基于熵权TOPSIS法和RSR法对不同医疗保险下的老年人健康状况评价

目的 运用熵权TOPSIS（Entropy weight TOPSIS）法与秩和比（RSR）法综合评价我国2018年四种医保下老年人健康状况，为决策者制定相关政策提供参考依据。方法 以中国老年健康影响因素跟踪调查（CLHLS)中的5种健康指标(自评健康率、健康改善率、他评健康率、ADL完好率、慢性病患病率）为基础，使用 Excel 和SPSS 22.0 软件，采取熵权TOPSIS和RSR相结合的方法对我国2018年各医保类型下老年人健康状况进行综合评价并分档。结果 不同医保下居民健康状况存在差异。熵权TOPSIS法和RSR法评价结果一致，排序均为商业医疗保险、公费医疗、新型农村合作医疗保险、城镇职工/居民医疗保险。RSR法分档结果为三档，商业医疗保险被评为“优秀”（RSRi＞0.679），公费医疗、新型农村合作医疗保险、城镇职工/居民医疗保险均被评为“良好”（0.504≤RSRi＜0.679），无被评为“一般”（RSRi＜0.504）。且方差分析显示各档差异具有统计学意义（F=51.766，P＜0.001）。讨论 增强对医疗保险不公平性的重视；建立全民统一的基本医疗保险框架；加强对弱势群体的保护。

Comprehensive evaluation on the health status of the elderly in China in 2018 with Entropy weight TOPSIS and RSR methods

Objective To comprehensively evaluate the health status of the elderly under four kinds of medical insurance in 2018, and provide evidence for policy-making. Methods Based on 5 health indicators(self-rated health rate, health improvement rate, other rated health rate, ADL intact rate, prevalence rate of chronic disease) in the Chinese Longitudinal Healthy Longevity Survey(CLHLS), using Excel and SPSS 22.0 software, Entropy Weight TOPSIS and RSR method were used to comprehensively evaluate and grade the health status of the elderly under various types of medical insurance in 2018. Results There were differences in the health status of residents across different medical insurance. The results of Entropy Weight TOPSIS method and RSR method were consistent, ranking commercial medical insurance, public medical insurance, new rural cooperative medical insurance and urban workers/residents medical insurance. In fact, RSR method was divided into three grades: commercial medical insurance was rated as "excellent"(RSRi>0.679), public medical insurance, new rural cooperative medical insurance and urban employee/resident medical insurance are rated as "good"(0.504≤RSRi<0.679), and none as "average"(RSRi<0.504). And the analysis of variance showed that the difference was statistically significant(F=51.766, P<0.001). Discussion It is suggested to pay more attention to the inequity of medical insurance, establish a unified basic medical insurance framework for all and strengthen the protection of vulnerable groups.