我国公共卫生支出水平的空间格局及动态演变

The Spatial Pattern and Dynamic Evolution of Public Health Expenditure in China

借助中国大陆1997—2015年的省级面板数据,运用GIS技术、Dagum基尼系数和Kernel密度估计与Markov链相结合的分析方法,对公共卫生支出水平的空间格局分异及动态演变过程进行测度。GIS可视化方法表明公共卫生支出具有明显的阶段特征和空间非均衡特征。从Dagum基尼系数来看,人均财政医疗卫生支出在地区间具有层次性差距,中部地区在财政医疗卫生支出方面具有显著的均衡性。对比来看,以绝对指标衡量的财政医疗卫生支出的地区差距明显大于相对指标,换言之,医疗卫生支出占财政支出的比重所度量的财政医疗卫生支出的空间分布更为均衡。从Kernel密度估计结果来看,东、西部地区人均财政医疗卫生支出水平的区域内部差异较大,医疗卫生支出占财政支出的比重的地区差距有进一步增大的可能。Markov链分析表明,公共卫生支出水平状态之间的流动性正在得到改善,有助于地区间的人均财政医疗卫生支出水平实现"收敛",但初始公共卫生支出水平较低的省份若要取得跨越式发展则十分困难。以此为基础,在明晰我国公共卫生支出水平地域分异规律的前提下,从空间均衡理念出发,提出促进公共卫生支出均等化建构的对策建议。

Based on the provincial panel data of China from 1997 to 2015, the spatial pattem differentiation and dynamic evolution of public health expenditure level were analyzed by using GIS technology, Dagum Gini coefficient and Kernel density estimation and Markov chain analysis method. GIS visualization method shows that public health expenditure has obvious characteristics of stage and significant spatial non-equilibrium characteristics. From the Dagum Gini coefficient and its decomposition results, the per capita fiscal and health expenditure has obvious level gap between regions, and the central region has significant fairness in public health expenditure. In contrast, the regional disparities in public health expenditure as measured by absolute indicators are significantly greater than the relative indicators, in other words, the spatial distribution of fiscal and health expenditure is more balanced by the proportion of medical and health expenditure to fiscal expenditure. From the Kernel density estimation results, the regional differences in the level of per capita fiscal and health expenditure in the eastern and western regions are still large, and the regional disparity between medical and health expenditure as the proportion of fiscal expenditure is further increased. Markov chain analysis shows that the liquidity between the levels of public health expenditure is improving and that the level of per capita fiscal and health expenditure in the region is ＂convergent, but the provinces with lower levels of initial fiscal and health expenditure are expected to It is very difficult to develop by leaps and bounds. Based on the law of regional distribution of public health expenditure in China, from the idea of spatial equilibrium, this paper puts forward the countermeasures and suggestions to promote the construction of equalization of public health expenditure.