School of Public Administration, Huazhong Agricultural University, Wuhan, China.
Asia-Pacific Institute of Ageing Studies, Lingnan University, Tuen Mun, Hong Kong SAR, China.
Front Public Health. 2023 Jun 15;11:1173197. doi: 10.3389/fpubh.2023.1173197. eCollection 2023.
The efficiency of primary health care services is drawing increased attention worldwide, especially in developing countries. Health care reform in China has moved into the 'deep water zone' phase and is facing the dilemma of inefficiency in primary health care services, which is a critical challenge for universal health coverage.
In this study, we estimate the efficiency of primary health care services in China and its determinants. A combination of a super-SBM (Slack-Based Measure) model, a Malmquist productivity index model and a Tobit model is used to study provincial panel data, and the results demonstrate the inefficiency of primary health care services in China and the variations in efficiency values between regions.
Over time, the productivity of primary health care services shows a decreasing trend, mainly due to slowing technology change. Financial support is needed to improve the efficiency of primary health care services, but it is worth noting that existing social health insurance coverage decreases efficiency, while economic development, urbanization and education also have a significant impact.
The findings suggest that increasing financial support should remain a priority in developing countries but that reasonable reimbursement design, appropriate payment methods and comprehensive supporting social health insurance policies are key to the next step of reform.
初级卫生保健服务的效率在全球范围内越来越受到关注，特别是在发展中国家。中国的医疗改革已经进入“深水区”阶段，面临着初级卫生保健服务效率低下的困境，这是全民健康覆盖的一个关键挑战。
本研究采用超 SBM（基于松弛的衡量）模型、Malmquist 生产力指数模型和 Tobit 模型的组合，对中国省级面板数据进行研究，结果表明中国初级卫生保健服务存在效率低下的问题，且地区间效率值存在差异。
随着时间的推移，初级卫生保健服务的生产力呈下降趋势，主要是由于技术变化放缓。需要增加财政支持来提高初级卫生保健服务的效率，但值得注意的是，现有的社会医疗保险覆盖率会降低效率，而经济发展、城市化和教育也有显著影响。
研究结果表明，增加财政支持仍应是发展中国家的重点，但合理的报销设计、适当的支付方式以及全面的社会医疗保险政策支持是改革的下一步关键。
