撤乡并镇后四川省乡镇卫生院医疗服务投入产出效率变化分析  

Research on the Changes in Input-Output Efficiency of Medical Services in Township Health Centers in Sichuan after the Implementation of Township Merger Policy

作　　者：孙群[1] 杨练[2] 冯琳 张雪莉 胡怡苹[5] Sun Qun(School of Management,Chengdu University of Traditional Chinese Medicine,Chengdu,P.R.China)

机构地区：[1]成都中医药大学管理学院,四川成都611137 [2]成都中医药大学公共卫生学院 [3]四川省卫生健康委员会 [4]四川省卫生健康信息中心 [5]四川大学华西第二医院

出　　处：《中国卫生事业管理》2024年第9期1000-1003,共4页Chinese Health Service Management

基　　金：国家自然科学基金资助项目“吸烟与贫困:健康效应与挤出效应分析”(71603032);川北医学院2021年度四川省基层卫生事业发展研究中心资助项目“‘两项改革’背景下四川省乡镇卫生院运营效率评价及提升策略研究:基于时空视角”(SWFZ21-Q-50)。

摘　　要：目的:分析撤乡并镇后四川省乡镇卫生院医疗服务投入产出效率变化情况,为助力乡村医疗卫生体系健康发展提供参考依据。方法:以2018~2022年四川省5个样本市州48个区县为决策单元,采用BCC模型和Malmquist指数模型进行静态与动态效率分析。结果:2018~2022年样本市州乡镇卫生院机构数累计减少37.8%,院均床位数、职工人数、设备台数与医疗服务量累计增长率在49.8%~93.9%之间。医疗服务投入产出综合效率、技术效率和规模效率均值分别由2018年的0.800、0.843和0.950,变化为2022年的0.766、0.796和0.961。2018~2022年全要素生产率指数、技术进步指数和技术效率指均值分别为0.986、1.003和0.983。与2018年相比,2022年DEA无效区县数增加、减少和不变的市州数分别有2个、2个和1个。全要素生产率指数>1的区县数占比依次为成都62.5%、攀枝花40.0%、南充33.3%、阿坝23.1%和内江20.0%。结论:撤乡并镇后,四川省乡镇卫生院“小、散、弱”问题有效缓解,医疗服务投入产出规模效率有所提升;综合效率未见明显改善,技术效率下降是其主要原因;效率变化地区间差异明显。建议做好撤乡并镇改革“后半篇”文章,继续深化和拓展改革成果,以提升医疗技术水平和管理能力为关键点,区分不同地区共性与个性问题,多措并举推动乡镇卫生院量变成果转变为质变效果。Objective To analyze the changes in input-output efficiency of medical services in township health centers in Sichuan after township merger policy implementation,so as to provide reference for promoting the healthy development of rural medical and health systems.Methods Taking 48 counties in 5 sample cities in Sichuan from 2018 to 2022 as the decision making units,the BCC model and Malmquist index model were used to statically and dynamically measure the input-output efficiency of medical services in township health centers.Results From 2018 to 2022,the total number of township health centers in sample cities was decreased by 37.8%,with an average increase of 49.7%~93.9%in the number of sickbeds,number of employees,number of medical equipment,and numbers of medical services per township health center.The average input-output comprehensive efficiency,technical efficiency,and scale efficiency of medical services changed from 0.800,0.843,and 0.950 in 2018 to 0.766,0.796,and 0.961 in 2022,respectively.From 2018 to 2022,the average TFP,technical change index,and technical efficiency change index was 0.986,1.003,and 0.983,respectively.Compared with those in 2018,there were 2,2,and 1 cities in 2022 with an increase,decrease,and no change in the number of DEA ineffective counties.The proportions of counties with TFP>1 in the sample cities were 62.5%in Chengdu,40.0%in Panzhihua,33.3%in Nanchong,23.1%in Aba,and 20.0%in Neijiang.Conclusion After the implementation of township merger policy,the problems of small,scattered and weak township health centers in Sichuan were alleviated,and the scale efficiency was improved.However,there was no significant improvement in comprehensive efficiency,mainly due to technical efficiency decreasing.Efficiency changes among different regions were quite different.It is suggested to further improve the township merger policy in the second half,focus on improving medical technology and management capabilities,and take multiple measures to promote the transformation of township health centers

关 键 词：撤乡并镇 乡镇卫生院 效率评价 数据包络分析 MALMQUIST指数 

分 类 号：R197.6[医药卫生—卫生事业管理]