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中国医疗服务供给的时空演变与发展路径。

Spatiotemporal evolution and development path of healthcare services supply in China.

机构信息

School of Finance and Public Administration, Yunnan University of Finance and Economics, Kunming, 650221, People's Republic of China.

出版信息

BMC Health Serv Res. 2024 Oct 18;24(1):1258. doi: 10.1186/s12913-024-11545-4.

Abstract

OBJECT

Promoting the accessibility and equity of healthcare services, as well as enhancing service capacity, are crucial for building a sound healthcare system. Particularly in the past two years of the normalized COVID-19 situation, this issue has garnered widespread attention in the academic community. This study aims to investigate and analyze the characteristics and trends of the spatial-temporal evolution of healthcare service supply levels in China. It also seeks to explore the influencing factors and pathways for development, with the goal of optimizing the allocation of healthcare resources.

METHODS

This article uses the entropy weight TOPSIS method combined with Dagum Gini coefficient and Kernel density to evaluate the supply level of healthcare services in 31 provinces and cities in China from 2012 to 2020, and explores its development and spatial pattern characteristics. Then, through Moran index, panel regression model and spatial econometric testing, the spatial correlation problem and its influencing factors are further analyzed, and targeted policy recommendations are proposed based on it, laying the foundation for further promoting the balanced development of healthcare service supply capacity.

RESULTS

(1) Healthcare services supply levels in various provinces and cities in China have significantly increased, with a shift in spatial distribution from 'higher in the east and lower in the west' to 'convergence between east and west, with lower levels in the central regions.' (2) Relative differences among regions are narrowing annually, primarily due to interactions between the four regions rather than within each region, with expanding impact of overlapping regions. (3) Absolute differences among regions are also decreasing, moving towards uniformity with a contraction of extension and a restraint on the trend towards multipolarization. (4) Spatial correlation between adjacent regions is weakening, eventually becoming non-significant, with fading spatial effects. (5) The correlation between local economic development, population factors, institutional arrangements, and the current state of supply is significant, and the research design and conclusions remain robust even after thorough consideration of spatial effects. The study explores the development pathways based on the objective existence of regional development and the controllable government actions.

CONCLUSION

The overall level of healthcare service supply in China has improved, but regional differences still exist. The objective level of regional development and the subjective behavior of local governments have a significant impact on the supply of healthcare services. Therefore, it is recommended that each region adapt to local conditions, identify its own strengths and weaknesses, coordinate resource supply and demand, consider the impact of key factors, and optimize the allocation of healthcare development resources.

摘要

目的

促进医疗保健服务的可及性和平等性,提高服务能力,是健全医疗保健体系的关键。特别是在过去两年常态化新冠疫情背景下,这一问题在学术界受到广泛关注。本研究旨在调查和分析中国医疗服务供给水平的时空演变特征和趋势,并探讨其发展的影响因素和路径,以期优化医疗资源配置。

方法

本文采用熵权 TOPSIS 法结合 Dagum 基尼系数和核密度函数,对 2012—2020 年中国 31 个省(市)的医疗服务供给水平进行评价,并对其发展及空间格局特征进行探讨。然后,通过 Moran 指数、面板回归模型和空间计量检验,进一步分析空间关联问题及其影响因素,并提出有针对性的政策建议,为进一步促进医疗服务供给能力的均衡发展奠定基础。

结果

(1)中国各省份医疗服务供给水平显著提高,空间分布由“东高西低”转变为“东西收敛,中部偏低”。(2)区域间相对差异逐年缩小,主要是由于四大区域间的相互作用,而不是各区域内的相互作用,重叠区域的影响不断扩大。(3)区域间绝对差异也在减小,趋向均匀,扩张收敛,多极化趋势受到抑制。(4)相邻区域间的空间相关性减弱,最终变得不显著,空间效应逐渐消失。(5)局部经济发展、人口因素、制度安排和供给现状之间的相关性显著,在充分考虑空间效应的情况下,研究设计和结论仍然稳健。研究基于区域发展的客观存在和政府可控行为,探索发展路径。

结论

中国医疗服务供给整体水平提高,但地区间差异仍然存在。区域客观发展水平和地方政府主观行为对医疗服务供给有显著影响。因此,建议各地区因地制宜,认清自身优势和劣势,协调资源供需,考虑关键因素的影响,优化医疗发展资源配置。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0cc2/11487962/3df16551c112/12913_2024_11545_Fig1_HTML.jpg

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