基于链式网络DEA模型的基本医疗服务均等化研究

Research on the Equalization of Basic Medical Service Based on the Chain Network DEA Model

以往的基本医疗服务均等化研究文献注重对现状和对策研究,对基本医疗服务均等化的理解停留在控制某项指标缩小差异的基础上,忽略医疗卫生服务系统的投入产出逻辑。本文通过建立基本医疗服务投入产出框架,以改善地区之间的效率差异、实现地区间医疗卫生发展均等化为理论基础,运用链式网络DEA(data envelopment analysis)模型,计算各地区之间的投入产出效率,从各个子系统出发控制单个变量来实现医疗卫生投入产出效率的均等化。实证分析表明,现阶段调整财政医疗卫生支出不会提高各地区的效率水平,但能够缩小地区之间的投入产出效率差距。各地区财政性医疗卫生投入应该以医疗卫生投入产出效率高低为参考标准,有针对性地、差异化地安排财政预算。

Previous studies on the equalization of basic medical services mainly focused on the analysis of existing problems and came up with countermeasures; they were inspired by an understanding that the control of certain indicators to narrow their gaps was the main method to achieve the equalization of basic medical services; however, they did not pay enough attention to the input-output logic of the medical and health service system. Against the framework of the input-output logic and taking the elimination of efficiency differences between regions as the way to realize the equalization of medical and health development, this paper adopts the chain network DEA （data envelopment analysis） model to calculate the input-output efficiencies among different regions; and it achieves the equalization of input-output efficiency of medical and health care by controlling single variables from different subsystems. The empirical analysis shows that for the time being adjusting fiscal health care spending will not improve the efficiency level of different regions, but it can narrow down the gap of the input-output efficiencies among different regions; it also reveals that regional fiscal health input should take the input-output efficiency of medical and health care as the yardstick thus budgets being differentiated in accordance.