公共卫生支出、人口聚集与医疗卫生服务均等化

Public Health Expenditures,Population Aggregation and the Equalization of Basic Public Health Services

我国各省医疗卫生服务均等化水平呈现出时空分异特征。现有文献在分析造成医疗卫生服务均等化时空分异的原因时,都忽视了医疗卫生服务均等化的空间溢出效应和门槛效应。文章借助我国1995-2012年省级面板数据,应用空间计量模型对医疗卫生服务均等化的主要影响因素进行估计,结果显示:公共卫生支出强度、政府转移支付力度以及人口聚集度不同是造成医疗卫生服务均等化时空分异的主要原因。门槛面板模型检验发现,公共卫生支出强度和人口聚集度对医疗卫生服务均等化具有门槛效应,公共卫生支出强度提升至一定门槛值时,对医疗卫生服务均等化提升作用明显提高;而人口聚集度与医疗卫生服务均等化之间呈倒U形关系,即随着人口聚集度的不断提高,人口聚集对医疗卫生服务均等化作用呈现先增加后减小的变化趋势。因此,中央政府应持续提高政府转移支付力度,充分发挥政府转移支付对医疗卫生服务均等化的促进作用,努力缩小医疗卫生服务区域差异;省级政府应结合自身公共卫生支出结构及城镇化进程,采取差异化的医疗卫生服务均等化提升战略。

The equalization level of provincial basic public health services in China is featured by temporal and spatial differentiation. As for the analysis of reasons for temporal and spatial dif- ferentiation of the equalization of basic public health services, current literature always ignores spatial spillover and threshold effects of the equalization of basic public health services. This pa- per applies spatial econometric regression model to estimate key factors influencing the equaliza- tion of basic public health services based on the provincial panel data from 1995 to 2012 in China. It arrives at the result that public health expenditures, transfer payments and differences in popu- lation aggregation are the main reasons for temporal and spatial differentiation of the equalization of basic public health services. Threshold panel model tests show that public health expenditures and population aggregation have threshold effects on the equalization of basic public health serv- ices, and when public health expenditure intensity increases to a certain threshold level, its pro- motion role in the equalization of basic public health services significantly improves. And the rela- tionship between population aggregation and the equalization of basic public health services is the inverted U-shape, namely with the constant increase in population aggregation, the role of popu- lation aggregation in the equalization of basic public health services experiences a trend from in- crease to decrease. Therefore, the central government should continue to increase transfer pay- ments, make full use of the promotion role of transfer payments in the equalization of basic public health services, and make efforts to reduce the regional differences in basic public health services. Provincial governments should take differentiated strategy concerning the improvement of the e- qualization of basic public health services considering their own basic public health services struc- ture and urbanization process.