School of Public Administration & Emergency Management, Jinan University, 510632, Guangzhou, China.
School of Public Administration & Emergency Management, Jinan University, 510632, Guangzhou, China; Research Center of Social Security, Wuhan University, 430072, Hubei, China.
Public Health. 2019 Jun;171:139-147. doi: 10.1016/j.puhe.2019.04.003. Epub 2019 May 24.
Inefficient rural medical service systems are one of major obstacles to the Deepening Healthcare Reform. The objectives of this work are to analyze the efficiency of China's rural medical service systems and explore the key related factors.
Two-stage study including measuring efficiency and identifying factors.
An output-oriented slacks-based data envelopment analysis model was used to measure the efficiency, and a Spearman rank correlation analysis and a multiple linear regression model were used to explore the factors.
For the village-level medical service system, 20 out of 27 provinces were inefficient in 2013-2017, 12 out of 27 provinces had the efficiency lower than the average scores in 2013-2017 (0.633, 0.659, 0.638, 0.603, and 0.589), Guangdong had the highest scores of 1 in 2014-2017, whereas Tibet had the lowest scores (0.064-0.083) in 2013-2017, and the west region performed worst. For the township-level medical service system, 11 out of 27 provinces were inefficient in 2013-2017, 10 out of 27 provinces had the efficiency lower than the average scores in 2013-2017 (0.819, 0.791, 0.757, 0.787, and 0.811), Ningxia had the highest efficiency of 1 in 2013-2017, whereas Jilin had the lowest efficiency (0.313-0.370), and the central region performed worst. Additionally, rural residents' income was positively associated with the efficiency of village-level medical services, while the proportion of the vulnerable population was positively associated with the efficiency of township-level medical services.
Most provinces had inefficient rural medical service systems in 2013-2017. The efficiency scores varied greatly across provinces, and most scores changed a little over time. Imbalances in the development of rural medical service systems existed across regions, and the efficiency of village-level medical services and township-level medical services was associated with different factors.
农村医疗服务体系效率低下是深化医疗改革的主要障碍之一。本研究旨在分析中国农村医疗服务体系的效率，并探讨关键相关因素。
包括测量效率和识别因素的两阶段研究。
采用面向产出的松弛数据包络分析模型来测量效率，采用 Spearman 秩相关分析和多元线性回归模型来探讨因素。
2013-2017 年，27 个省份中有 20 个村级医疗服务系统效率低下，27 个省份中有 12 个省份的效率低于 2013-2017 年的平均分数（0.633、0.659、0.638、0.603 和 0.589），2014-2017 年广东得分最高为 1，而西藏得分最低（0.064-0.083），西部地区表现最差。2013-2017 年，27 个乡镇级医疗服务系统中有 11 个效率低下，27 个省份中有 10 个省份的效率低于 2013-2017 年的平均分数（0.819、0.791、0.757、0.787 和 0.811），2013-2017 年宁夏得分最高为 1，而吉林得分最低（0.313-0.370），中部地区表现最差。此外，农村居民收入与村级医疗服务效率呈正相关，而弱势群体比例与乡镇级医疗服务效率呈正相关。
2013-2017 年，大多数省份农村医疗服务体系效率低下。各省得分差异较大，且随着时间的推移变化不大。农村医疗服务体系发展存在地区不平衡，村级医疗服务和乡镇级医疗服务的效率与不同因素相关。
