2010—2016年京沪卫生发展效率的比较分析

Comparative analysis on the developing efficiency of health in Beijing and Shanghai between 2010 and 2016

目的对2010—2016年北京市和上海市卫生发展效率进行比较分析,归纳两市卫生发展的特点和问题,为我国以北京市、上海市为代表的超大城市卫生发展决策提供建议.方法基于专家咨询结论,确定数据包络分析指标维度,根据2010—2016年中国卫生统计年鉴和全国卫生财务年报建立包括北京市、上海市在内的20个省(直辖市)的相关指标数据库,采用数据包络分析方法,运用DEAP软件以及MATLAB的Linprog程序进行数据统计,对京沪卫生发展效率进行量化分析.结果北京市卫生体系综合效率低于上海市,但不断上升.北京市人力投入效率较低,卫生总费用投入高于目标值.健康产出方面,京沪两地产出值与目标值差距不大,北京市筹资风险保护指标效率较高.服务量产出方面,京沪服务量产出效率水平提高,上海市的医师负荷效率高于北京市.结论北京市提升卫生体系综合服务效率举措有成效,值得其他地区借鉴.建议北京市以健全医疗保障体系为抓手,提升卫生经费使用效率.上海市应优化医师工作负荷,从人才角度推动分级诊疗制度建设.

Objective To compare and analyze the developing efficiency of health in Beijing and Shanghai between 2010 and 2016,to summarize characteristics and problems of health development in two cities and to provide suggestions for health decision-makings in mega cities similar with Beijing and Shanghai. Methods The indicator dimensions of the data envelopment analysis(DEA)were determined based on expert consultation. The DEA method,based on the database of 20 provinces and cities such as Beijing and Shanghai according to China Health Statistical Yearbook and the National Health Financial Yearbook from 2010 to 2016,the Linprog program of the MATLAB and the DEAP software were used to analyze and to quantify heath development efficiency in Beijing and Shanghai. Results The comprehensive efficiency of Beijing’s health system was lower than that of Shanghai,while it showed an obvious trend of rising. The input efficiency of human resources in Beijing was relatively lower,while the total health expenditure was higher than the target value. In terms of the health output,there was barely difference between the real value and target value of Beijing and Shanghai,and the efficiency of risk protection for fund-raising in Beijing was higher. For the service output,the efficiency level of service output increased sufficiently in Beijing and Shanghai,but the physician work-load efficiency in Shanghai was higher than that in Beijing. Conclusion Effects achieved in improving the comprehensive health service efficiency in Beijing are worthy of sharing with other regions. It is suggested that Beijing improve the efficiency of health expenditure,based on a fully-developed medical security system. On the other hand,it is suggested that Shanghai optimize the workload of doctors and promote the construction of tiered medical treatment and diagnosis system from the perspective of human resources.