摘要
目的:从财政医疗卫生支出视角探究地方政府的竞争对医疗服务效率的影响,为我国医疗卫生体系的建设提供建议。方法:运用非期望产出的SBM(slacks-based measure)方法,以2010-2021年我国31个省份的面板数据为样本,对我国医疗服务效率进行测度,其后利用面板Tobit模型,以财政医疗卫生支出为中介变量,实证检验地方政府的竞争、财政医疗卫生支出与医疗服务效率之间的关联。结果:我国省级医疗服务效率整体向好,年均增长率为1.3%,但区域差异显著;地方政府的竞争对医疗服务效率具有显著负向影响,但该结果在发达地区并不显著;财政医疗卫生支出在其中起部分中介效应,中介效应占比14.2%;在全国,总抚养比、人均绿地面积、财政支出分权显著提升医疗服务效率。在发达地区,财政自给度与医疗服务效率成正比;在欠发达地区,城镇化与医疗服务效率负相关。结论:地方政府的竞争通过减少财政医疗卫生支出规模进而降低医疗服务效率。后续应建立地方政府竞争动态均衡机制、建立政府绩效考核柔性机制、健全地方政府竞争监督约束机制以及完善医疗卫生预算机制。
Objective:To explore the impact of local government competition on the efficiency of medical services from the perspective of financial healthcare expenditures,so as to provide suggestions for the construction of China's healthcare system.Methods:Using the SBM method with non-expected outputs,this study measured the efficiency of China's medical services using panel data from 31 provincial-level administrative regions in China from 2010-2021 as a sample,and subsequently utilized the panel Tobit model to empirically test the associations between local government competition,fiscal healthcare expenditures and healthcare service efficiency using fiscal healthcare expenditures as a mediator variable.Results:Provincial medical service efficiency in China was generally good,with an average annual growth rate of 1.3%,but with significant regional differences.Local government competition had a significant negative effect on medical service efficiency,but this result was not significant in developed areas.Fiscal health care expenditure played a part in the mediating effect,with a mediating effect of 14.2%.In the whole country,the total dependency ratio,green space per capita,and decentralization of fiscal expenditure significantly improved medical service efficiency.In developed regions,fiscal self-sufficiency was positively related to medical service efficiency.In less developed regions,urbanization was negatively related to medical service efficiency.Conclusion:Local government competition reduces the efficiency of medical services by reducing the scale of financial medical expenditures.A dynamic equalization mechanism for local government competition,a flexible mechanism for government performance appraisal,a sound mechanism for monitoring and restraining local government competition,and an improved mechanism for health care budgeting should be established in the future.
作者
吴庆玲
舒燕
WU Qingling(School of Public Health and Management,Guangzhou University of Traditional Chinese Medicine,Guangzhou,Guangdong,510006,China)
出处
《医学与社会》
北大核心
2024年第1期50-56,共7页
Medicine and Society
基金
教育部人文社会科学研究规划基金资助项目,编号为21YJAZH074
广东省哲学社科规划课题,编号为GD22XGL51
广东省教育科学规划课题,编号为2022GXJK061
广州中医药大学2020年度人文社科项目重点专项,编号为2020SKZD07。
关键词
医疗服务效率
地方政府
竞争
财政分权
Efficiency of Medical Service
Local Government
Competition
Fiscal Decentralization
