基于Bootstrap-Malmquist指数模型的我国基层医疗卫生机构投入产出效率评价

Evaluation on Input-output Efficiency of Grassroots Medical and Health Institutions in China Based on Bootstrap-Malmquist Index Model

目的:分析2012-2018年我国基层医疗卫生机构的投入产出效率,为改进和优化基层医疗资源的投入使用提供理论依据,为基层医改政策的制定提供借鉴。方法:采用Bootstrap-DEA法对传统的DEA分析方法进行纠偏,采用Malmquist指数方法进行动态分析。结果:2012-2018年我国基层医疗卫生机构的整体投入产出效率呈现下降趋势,2018年纠偏后的投入产出效率仅为0.731;2012-2018年东、中、西部地区基层医疗卫生机构投入产出效率平均值分别为0.800、0.718和0.726。2013年后全要素生产率一直在降低,年均降幅达到3.7%;技术进步效率达标的省份仅有2个(6.45%)。结论:新医改以来我国基层医疗卫生机构的资源投入不断增加,但是其投入产出效率整体呈下降趋势,技术进步效率成为主要制约因素,东、中、西部地区存在明显地域差异。按需配置医疗资源,关注资产的投入使用情况,提升基层医疗卫生机构的医疗技术应该成为未来关注的重点之一。

Objective:To analyze the input-output efficiency of grassroots medical and health institutions in China from 2012 to 2018,so as to provide a theoretical basis for improving and optimizing the input and utilization of grassroots medical resources and provide references for formulating the grassroots medical reform policies.Methods:The Bootstrap-DEA method was used to correct the deviation of the traditional DEA analysis method,and the Malmquist index method was used for dynamic analysis.Results:From 2012 to 2018,the overall input-output efficiency of grassroots medical and health institutions in China showed a downward trend.The input-output efficiency after correction in 2018 was only 0.731.The average input-output efficiency of grassroots medical and health institutions in eastern,central and western regions was 0.800,0.718 and 0.726.After 2013,the total factor productivity had been declining with an average annual decrease of 3.7%.Only two provinces(6.45%)had reached the technical progress efficiency standard.Conclusion:Since the new medical reform,the resource input of grassroots medical and health institutions in China has been increasing,but the input-output efficiency has been on the decline as a whole.The technical progress efficiency is the main restraining factor.There are obvious regional differences in the eastern,central and western regions.Allocating medical resources on demand,paying attention to the investment and use of assets and improving the medical technology of grassroots medical and health institutions should be the focuses in the future.