“新医改”十年：中国医疗卫生服务效率的区域差异、动态演进及影响因素研究

doi:10.16381/j.cnki.issn1003-207x.2021.0539

摘要/Abstract

摘要： 本文基于非期望产出-超效率SBM模型测度了2009-2018年全国31个省（市、自治区）的医疗卫生服务效率，采用Dagum基尼系数和Kernel密度估计法探究了我国医疗卫生服务效率的区域差异及动态演进过程，并通过空间杜宾模型分析了其影响因素及空间溢出效应。研究发现：全国及东、中、西和东北四大区域的医疗卫生服务效率均呈逐渐提高趋势，高效率省份比重逐渐增大，低效率省份占比逐渐减少；中国医疗卫生服务效率的总体差距呈下降趋势，中部和西部地区的区域内差距逐渐缩小，而东部和东北地区的区域内差距呈现扩大趋势，四大区域医疗卫生服务效率的区间差距均呈缩小趋势，医疗发展与改革过程中存在的部分交叉重叠问题是导致医疗卫生服务效率总体差距的主要来源；东部和东北地区基本无极化现象，而中部和西部地区大部分年份呈现两极分化现象；中国医疗卫生服务效率存在显著且积极的空间溢出效应，人均可支配收入与技术人员占比对医疗卫生服务效率存在显著负向直接作用，等级医院占比具有显著的负向溢出效应，而人口密度和老年抚养比的正向直接作用与溢出效应均非常显著。

关键词: 医疗效率；非期望产出-超效率SBM；Dagum基尼系数；Kernel密度估计；空间杜宾模型

Abstract: Based on the undesired output-super-efficiency SBM model, the efficiency of medical and health services in 31 provinces, autonomous regions and municipalities in China from 2009 to 2018 is measured, and the regional gap and dynamic evolution of health and medical efficiency is explored by using the Dagum Gini coefficient and Kernel density estimation methods. The spatial spillover effect of its influencing factors is also exhibited through the spatial Dubin model. The results can be exhibited as follows: (1) The efficiency of medical and health services in China and the four major regions of the East, the Central, the West and the Northeast are gradually increasing. The proportion of high-efficiency provinces is gradually increasing, and the proportion of low-efficiency provinces is gradually decreasing. (2) A "declining" trend is presented in the overall gap in the efficiency of China’s medical and health services. The intra-regional gap between the central and western regions is gradually narrowed, while the intra-regional gap between the eastern and northeastern regions has presented a widening trend. The gaps in the efficiency of medical and health services in the four regions are all shrinking. Part of the overlap in the process of medical development and reform is the main source of the overall gap in the efficiency of medical and health services. There is basically no polarization in the efficiency of medical and health services in the eastern and northeastern regions, while polarization exists in the central and western regions for most years. (3) A significant and positive spatial spillover effect is exhibited in the Chinese medical and health service efficiency. Per capita disposable income and the proportion of technical personnel have a significant negative direct effect on the efficiency of medical and health services. Furthermore, the proportion of graded hospitals behaves a significant negative spillover effect. The positive direct effects and spillover effects of population density and old-age dependency ratio are both very significant.

Key words: medical efficiency; undesired output-super-SBM; Dagum Gini coefficient; kernel density estimation; spatial Durbin mode

中图分类号:

C93
R195

杨欢, 吕承超. “新医改”十年：中国医疗卫生服务效率的区域差异、动态演进及影响因素研究[J]. 中国管理科学, 2023, 31(2): 162-172.

YANG Huan, LV Cheng-chao. Ten Years of “New Medical Reform”: The Regional Differences, Dynamic Evolution and Influencing Factors of China’s Medical and Health Service Efficiency[J]. Chinese Journal of Management Science, 2023, 31(2): 162-172.

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