“十三五”期间新疆医疗卫生服务体系运行效率及空间自相关分析

Operational efficiency and spatial autocorrelation analysis of medical and health service system in Xinjiang during the 13th Five-Year plan period

目的通过研究新疆医疗卫生服务体系的运行效率,分析医疗资源配置过程中存在的问题、地州差异以及原因,为建立高质量高效率的医疗卫生服务体系运行机制提供决策依据。方法本研究数据来源于2017—2021年《新疆统计年鉴》及2016—2020年新疆卫生统计年报,研究对象为医疗卫生服务体系(包括医院、基层医疗卫生机构、专业公共卫生机构),根据以往文献研究和数据的可获得性确定投入产出指标,选择人均GDP、年末人口数及政府卫生支出为环境变量,通过三阶段DEA模型,排除环境因素和随机误差的影响,从静态角度分析十三五期间新疆医疗卫生服务体系的运行效率;使用Dagum基尼系数和莫兰指数分析效率值,探讨其有无空间依赖性。结果DEA模型显示:不考虑环境因素及随机误差的影响,十三五期间新疆医疗卫生服务体系效率整体较好,综合效率均值为0.919;SFA回归结果显示政府卫生支出的增加可以使医疗卫生服务体系效率提高(P<0.01);剔除环境因素及随机干扰的影响,新疆医疗服务体系综合效率均值为0.893,多处于规模递增或不变状态,区域内差异、区域间差异和超变密度对区域差异的年均贡献率依次为36.05%,33.32%,30.63%,莫兰指数结果显示新疆医疗卫生服务体系的运行效率仅2016年与2019年存在空间相关性(P=0.096,P=0.040)。结论十三五期间新疆医疗卫生服务体系运行效率处于波动状态,相较于纯技术效率而言,博尔塔拉蒙古自治州和克孜勒苏柯尔克孜自治州亟待改善其规模结构。环境因素中政府卫生支出对效率影响较大,政府可适当增加卫生投入。各地州间效率差距明显,且疆域间差异较大,提示各疆需要针对性解决效率不足的问题。

Objective By studying the operating efficiency of Xinjiang′s medical and health service system,the problems existing in the allocation of medical resources,differences between regions and states and their causes are analyzed to provide decision-making basis for the establishment of a high-quality and efficient operating mechanism of the medical and health service system.Methods The data in this study are derived from the Statistical Yearbook of Xinjiang from 2017—2021 and the Annual Report of Health Statistics of Xinjiang from 2016—2020.The research object is the medical and health service system(including grassroots medical and health institutions,hospitals,and professional public health institutions).Based on previous literature research and the availability of data,input and output indicators are determined,and GDP per capita,year-end population,and government health expenditure are selected as environmental variables.Through a three stage DEA model,The method of excluding environmental factors and random errors analyzes the operational efficiency of Xinjiang′s medical and health service system during the 13th Five Year Plan period from a static perspective;Dagum Gini coefficient and Moran index were used to analyze the efficiency value and explore whether there was spatial dependence.Results The DEA model shows that,without considering the impact of environmental factors and random errors,the overall efficiency of the medical and health service system in Xinjiang during the 13th Five Year Plan period is relatively good,with an average comprehensive efficiency of 0.919;The SFA regression results showed that the increase in government health expenditure can improve the efficiency of the medical and health service system(P<0.01);Excluding the impact of environmental factors and random interference,the average comprehensive efficiency of the medical service system in Xinjiang is 0.893,mostly in an increasing or constant state of scale.The annual contribution rates of intra regional differences,inter regional differences,and hypervariable density to regional differences are 36.05%,33.32%,and 30.63%,respectively.The results of the Moran index show that the operational efficiency of the medical service system in Xinjiang only has a spatial correlation between 2016 and 2019(P=0.096,P=0.040).Conclusions During the 13th Five Year Plan period,the operational efficiency of the medical and health service system in Xinjiang was in a fluctuating state.Compared to pure technical efficiency,Bortala Mongolian Autonomous prefecture and Kizilsu Kirgiz Autonomous Prefecture urgently need to improve their scale and structure.Among environmental factors,government health expenditure has a greater impact on efficiency,and the government can appropriately increase health investment.There is a significant difference in efficiency between different regions and states,and there are significant differences between territories,indicating that each region needs to address the issue of insufficient efficiency in a targeted manner.