分级诊疗后我国乡镇卫生院资源配置效率与公平性研究

Allocation efficiency and equity of township health center resources in China after hierarchical medical system reform

目的分析2015—2020年我国分级诊疗实施以来乡镇卫生院卫生资源配置效率和公平情况,为优化我国乡镇卫生院卫生资源配置、提升农村基层医疗卫生服务效率提供依据。方法运用三阶段DEA模型结合Malmquist指数对2015—2020年乡镇卫生院投入和产出数据效率进行静态和动态分析,再利用集中指数分析资源配置公平性。结果我国乡镇卫生院卫生资源配置平均综合效率为0.836,整体运行良好但效率处于退步状态。四大区域效率值表现出一定程度的逆向性,中部地区和西部地区的平均综合效率高于东部地区。65岁及以上人口占比对卫生资源配置效率有负向影响,对人均GDP、政府卫生支出有正向影响。乡镇卫生院全要素生产效率呈波动下降趋势,技术进步不足是主要原因。乡镇卫生院卫生资源配置逐年向经济水平低的省市倾斜。结论政府应因地制宜,合理规划农村医疗资源;加强农村基层医疗卫生人才队伍建设;推进乡镇卫生院标准化建设,提高医疗服务能力和水平,引导居民基层首诊;优化适老化医疗服务,发展健康养老服务。

Objective To analyze the changes in the allocation efficiency and equity of township health center resources from 2015 to 2020 during which the hierarchical medical system are carried out,and to provide basis for improving the rationality of health resource allocation and rural primary medical service efficiency.Methods The three-stage DEA model and Malmquist index were used for the static analysis and dynamic analysis of input and output efficiencies of township health centers during 2015 and 2020,and the concentration index was used to analyze the fairness of resource allocation.Results The average comprehensive efficiency of township health center resources in China was 0.836,suggesting an overall good operation but the efficiency was declined year by year.The resource allocation efficiency showed a certain degree of regional reverse,with the average comprehensive efficiency of the central and western regions higher than that of the eastern region.The proportion of people over 65 had a negative impact on the efficiency of health resource allocation,while per capita GDP and government health expenditure had a positive impact.The Malmquist index suggested that the total factor productivity efficiency of health resource allocation in township health centers showed a fluctuating downward trend,with lack of technological progress as the main reason.More health resources were inclined to be allocated to provinces and cities with low economic level year by year.Conclusion Government should deploy health resources rationally based upon local conditions,strengthen the development of rural medical personnel team,promote the standardization construction of township health centers,improve medical service capacity,and guide residents to be diagnosed and treated at the grassroots health institutions.Furthermore,it's recommended to optimize elderly-oriented medical service and develop health care service for the elderly.