基本公共服务质量评价研究——以基本医疗卫生服务为例

A Study on the Evaluation of the Quality of Basic Public Services——Taking the Quality of Basic Medical Service as An Example

文章采用全国大规模抽样调查数据,从县级和个体两个层面建构模型,以基本医疗卫生服务为例,定量研究基本公共服务质量如何受微观的个体选择与宏观的县域绩效和价值规范的影响。结果表明:在微观层面,选择参加医保的居民获得的基本医疗卫生服务满意度比未参保居民更高,但满意度差距受宏观绩效与价值规范的外在调节。具体表现在:一是县级层面的基本公共服务绩效总体水平能从宏观层面缩小参保居民与未参保居民之间的满意度差距,但在微观层次的政策作用相反。二是蕴含"公共性"价值规范的基本公共服务宏观质量,能从宏观和微观两个层面共同减少参保居民与未参保居民之间的满意度差异。数据揭示:如果把县域基本公共服务整体绩效作为质量评价的构成要素,就必须将"公共性"的价值追求作为质量测评的补充。

Based on large--scale sample survey data across China, models are constructed in this paper at both the county and the individual levels to perform a quantitative study of how the quality of basic public services is influenced by the microscopic factors at the individual level as well as the mac- roscopic factors at the county level, taking the quality of basic medical service as an Example. The re- sults show that, at the microscopic level, the residents participating in the medical care insurance ar- rangements are more likely to exhibit a higher degree of satisfaction than the non--participating resi- dents, while the satisfaction disparity is externally mediated by individual microscopic and county-- level macroscopic factors. To be more specific, there are two points worth noting. One is that the o- verall county--level quality of basic medical service helps to narrow the satisfaction disparity between the residents participating in the medical care insurance arrangements and the non--participating resi- dents, while the policies at the individual level have negative effects. The other is that the macroscopic quality of basic medical service whose value orientation favors publicity can reduce the satisfaction dis- parity between the two groups of residents at both the macroscopic and the microscopic levels. It is re- vealed by data that if the performance of basic medical service is to be the basic component of quality e- valuation, then the value orientation favoring publicity will need to be a necessary supplement to these quality evaluation operations.