Department of health services, The Fourth Military Medical University, 169 West of Changle Road, Xincheng District, Xi'an, Shaanxi, China.
Department of statistics, The Fourth Military Medical University, 169 West of Changle Road, Xincheng District, Xi'an, Shaanxi, China.
BMC Public Health. 2018 Feb 5;18(1):214. doi: 10.1186/s12889-018-5084-7.
The astonishing economic achievements of China in the past few decades have remarkably increased not only the quantity and quality of medical services but also the inequalities in health resources allocation across regions and inefficiency of the medical service delivery.
A descriptive analysis was used to compare the inequities in inputs and outputs of the provincial medical service systems, a non-radial super-efficiency data envelopment analysis model was then used to estimate the efficiency, and a regression analysis of the panel data was used to explore the determinants.
The inputs and outputs of most provincial medical service systems increased gradually from 2009 to 2014. Overall, the eastern region allocated more human and capital resources than the other two regions, and produced more than 50% of the total outpatient and emergency room visits, whereas the western region produced more inpatient services (about 30% of the total volume of inpatient services) according to the distribution of the population. The average efficiency scores of the provincial medical systems in China's mainland were 0.895, 0.927, 0.929, 0.963, 0.977 and 0.968 from 2009 to 2014, with a slight average improvement of 1.60%. The efficiency score of each provincial medical service system varied greatly from one another: Tibet (1.475 ± 0.057) performed extremely well, whereas several others including Heilongjiang (0.579 ± 0.001) performed poorly. Furthermore, the proportion of high-class medical facilities was negatively associated with efficiency, whereas the proportion of the vulnerable population, the per capita Gross Domestic Product, the proportion of the illiterate population and the improvement of primary health care had positive effects on efficiency.
Inequity in health resources allocation and service provision existed across the regions, but not all the gaps have begun to narrow since 2009. The difference of efficiency was great among provincial medical service systems but minor across regions, and the score changed very little over time. More importantly, the central region held the lowest average efficiency score in the past 6 years, while the western region held the largest average efficiency score at the first 5 years, which should receive enough attention of the government and decision-makers. In practice, efficiency was related to many complicated factors, indicating that the improvement of efficiency is a complex and iterative process that requires the strong cooperation of many sectors.
中国在过去几十年中取得了令人瞩目的经济成就，这不仅显著提高了医疗服务的数量和质量，还导致了地区间卫生资源配置的不平等和医疗服务提供的低效率。
采用描述性分析比较了省级医疗服务系统投入和产出的不平等，然后使用非径向超效率数据包络分析模型来估计效率，并使用面板数据回归分析来探讨决定因素。
大多数省级医疗服务系统的投入和产出从 2009 年到 2014 年逐渐增加。总体而言，东部地区比其他两个地区分配了更多的人力和资本资源，产生了超过 50%的总门诊和急诊人次，而西部地区则根据人口分布提供了更多的住院服务（约占住院服务总量的 30%）。中国内地省级医疗系统的平均效率得分从 2009 年到 2014 年分别为 0.895、0.927、0.929、0.963、0.977 和 0.968，平均提高了 1.60%。每个省级医疗服务系统的效率得分差异很大：西藏（1.475±0.057）表现非常出色，而其他一些地区，包括黑龙江（0.579±0.001）表现不佳。此外，高级医疗设施的比例与效率呈负相关，而弱势群体比例、人均国内生产总值、文盲人口比例和初级卫生保健的改善对效率有积极影响。
地区间存在卫生资源配置和服务提供的不平等，但自 2009 年以来并非所有差距都开始缩小。省级医疗服务系统之间的效率差异很大，但区域之间的差异很小，而且得分随时间变化很小。更重要的是，中部地区在过去 6 年的平均效率得分最低，而西部地区在前 5 年的平均效率得分最高，这应该引起政府和决策者的足够重视。在实践中，效率与许多复杂因素有关，这表明提高效率是一个复杂而迭代的过程，需要多个部门的密切合作。
