财政支出真的提升了医疗资源配置效率吗?

Did fiscal expenditure really improve the efficiency of medical resource allocation?

基于2011—2019年我国不含港澳台的31个省(自治区、直辖市)的面板数据,使用规模报酬可变的全局非径向非期望产出SBM-DEA模型,测度我国31个省(自治区、直辖市)的医疗资源配置效率,分析我国整体以及各地区医疗资源配置效率的时空演变趋势,并针对投入与产出进行投影分析。在此基础上,通过构建固定效应面板回归模型,检验医疗卫生财政支出对我国整体以及各地区医疗资源配置效率产生的影响。结果显示:第一,我国医疗资源配置效率表现为东部地区最高,西部地区次之,中部地区最低。尽管各地区之间效率值存在明显的差异性,但均表现为“U”型发展趋势;第二,我国各地区医疗资源均存在投入过度、期望产出不足以及非期望产出超标的现象,特别是中部地区最为严重;第三,医疗卫生财政支出对我国整体以及中部与西部地区医疗资源配置效率产生了严重的抑制效应,尤其是西部地区,但对东部地区不存在显著影响。因此,政府部门应当在减少医疗卫生财政支出规模的同时,持续深化医疗卫生体制改革,使医疗资源得到有效配置。

Based on the panel data of 31 provinces(municipalities and autonomous regions)in China from 2011 to 2019,this paper measures the allocation efficiency of medical resources in all provinces(municipalities and autonomous regions)in China by using the SBM-DEA model with variable returns to scale,analyzes the temporal and spatial evolution trend of the allocation efficiency of medical resources in China as a whole and in all regions,and makes projection analysis on input and output.On this basis,by constructing a fixed effect panel regression model,this paper examines how the medical and health financial expenditure has affected the efficiency of medical resource allocation in China as a whole and in various regions.The results show that:firstly,the efficiency of medical resource allocation in China is the highest in the eastern region,followed by the western region and the lowest in the central region.Although there are obvious differences in efficiency values among regions,they all show a U-shaped development trend.Secondly,there are over-investment,under-expected output and over-expected output of medical resources in all regions of China,especially in the central region.Thirdly,the financial expenditure on medical and health care has a serious restraining effect on the allocation efficiency of medical resources in China as a whole and in the central and western regions,especially in the western region,but it has no significant influence on the eastern region.The government should continue to deepen the reform of medical and health system while reducing the scale of medical and health expenditure,so that medical resources can be effectively allocated.