“双轨逻辑”下基层医疗卫生服务效率的时空演变与影响机制——基于2010—2020年省级面板数据的实证分析  

Spatio-Temporal Evolution and Influencing Mechanism of the Efficiency of Primary Medical and Health Care Services under the Two-Track Logic:An Answer from the Empirical Study Based on Provincial Panel Data from 2010 to 2020

作　　者：曾莉 吴瑞[1,2] 石慧 Zeng Li;Wu Rui;Shi Hui

机构地区：[1]华东理工大学,上海200237 [2]永康五金技师学院,金华321300 [3]湖南财政经济学院,长沙410205

出　　处：《上海行政学院学报》2024年第2期94-111,共18页The Journal of Shanghai Administration Institute

基　　金：国家社会科学基金项目“我国公共支出优先权的竞争及其协调机制研究”(19CGL046)的阶段性成果。

摘　　要：基层医疗卫生服务效率之于“强基层”战略具有特别重要的意义。本研究结合医疗卫生服务供给的“政府-市场”双轨逻辑,借助2010—2020年省级面板数据,运用DEA-Tobit模型分析了基层医疗卫生服务效率的演变态势及影响因素。研究发现,我国基层医疗卫生服务的综合效率不高,服务效率存在较大的区域差异且呈扩大趋势;全要素生产率呈现下降趋势,表现出政策驱动的不稳定特征。同时,横向竞争与基层医疗卫生服务效率之间呈现“倒U型”关系,竞争程度过小或过大都不利于效率的提高;纵向虹吸效应对基层医疗卫生服务效率有显著的负向影响;基层医疗卫生人员的投入规模显著抑制了服务效率,而卫生人员的投入质量却促进了服务效率。因此,我国应继续完善“强基层”的制度设计,注重医疗卫生领域的适度竞争,改善基层医疗卫生资源投入质量,缩小层级差距,以推进我国基层医疗卫生服务的高质量发展乃至健康中国建设。The efficiency of primary medical and health services is of great significance to the strategy of“Enhancing Grassroots”.Combined with the“government-market”dual-track operation logic of medical and health service supply,this study used DEA-Tobit model to analyze the evolution trend and influencing factors of primary medical and health service efficiency with the help of provincial panel data from 2010 to 2020.The study found that the comprehensive efficiency of primary medical and health services in China is not high,and there are big regional differences in service efficiency and the trend of expanding.The total factor productivity shows a downward trend,showing the cyclical characteristics driven by the policy.At the same time,there is an“inverted U-shaped”relationship between the degree of horizontal competition and the efficiency of primary medical and health services.Too little or too much competition is not conducive to the improvement of efficiency.The vertical siphon effect has a significant negative impact on the efficiency of primary medical and health services.The input scale of primary health care personnel significantly inhibits the service efficiency,while the input quality of health personnel promotes the service efficiency.Therefore,China should continue to improve the system design of“Enhancing Grassroots Strategy”,pay attention to the appropriate competition in the field of medical and health,improve the quality of primary medical and health resources input,and narrow the hierarchy gap,so as to promote the high-quality development of primary medical and health services in China and even the construction of healthy China.

关 键 词：基层医疗卫生 服务效率 “政府-市场”双轨逻辑 DEA-TOBIT模型 

分 类 号：R197.1[医药卫生—卫生事业管理]