School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing 211198, China.
Int J Environ Res Public Health. 2023 Jan 17;20(3):1664. doi: 10.3390/ijerph20031664.
China has established a comprehensive primary medical health service system, but the development of primary medical health services in the central and western regions is still unbalanced and insufficient. Based on data from 2010 to 2019, this paper constructs a super efficiency Slack-Based Measure model to calculate the supply efficiency of primary medical health services in 20 provinces and cities in central and western China. Using Kernel density estimation and Markov chain analysis, this paper further analyzes the spatial-temporal evolution of the supply efficiency of primary medical health services in central and western China, and also predicts the future development distribution through the limiting distribution of Markov chain to provide a theoretical basis for promoting the sinking of high-quality medical resources to the primary level. The results show that firstly, during the observation period, the center of the Kernel density curve moves to the left, and the main peak value decreases continuously. The main diagonal elements of the traditional Markov transition probability matrix are 0.7872, 0.5172, 0.8353, and 0.7368 respectively, which are significantly larger than other elements. Secondly, when adjacent to low state and high state, it will develop into convergence distributions of 0.7251 and 0.8243. The supply efficiency of primary medical health services in central and western China has the characteristics of high (Ningxia) and low (Shaanxi) aggregation respectively, but the aggregation trend is weakened. Thirdly, the supply efficiency of health services has the stability of keeping its own state unchanged, but the transition of state can still occur. The long-term development of the current trend cannot break the distribution characteristics of the high and low clusters, the efficiency will show a downward trend in the next 10-20 years, and still the problem of uneven long-term development emerges.
中国已经建立了全面的初级医疗卫生服务体系，但中西部地区初级医疗卫生服务的发展仍然不平衡和不足。本文基于 2010 年至 2019 年的数据，构建了超效率 Slack-Based Measure 模型，对中国中西部 20 个省、市的初级医疗卫生服务供给效率进行了测算。利用核密度估计和马尔可夫链分析，进一步分析了中国中西部初级医疗卫生服务供给效率的时空演变，并通过马尔可夫链的极限分布对未来发展分布进行了预测，为推动优质医疗资源下沉到基层提供了理论依据。结果表明：（1）观测期内，核密度曲线的中心向左移动，主峰值不断下降。传统马尔可夫转移概率矩阵的主对角元素分别为 0.7872、0.5172、0.8353、0.7368，均显著大于其他元素。（2）当相邻于低状态和高状态时，发展为收敛分布的概率分别为 0.7251 和 0.8243。中国中西部地区初级医疗卫生服务供给效率具有高（宁夏）低（陕西）集聚的特征，但集聚趋势减弱。（3）服务供给效率具有保持自身状态不变的稳定性，但状态的转变仍会发生。在当前趋势下，长期发展无法打破高低聚类的分布特征，效率在未来 10-20 年内将呈下降趋势，长期发展不平衡的问题仍然存在。
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