摘要
提高医疗卫生财政支出效率是全面推进健康中国建设、提升健康人力资本的重要保障。基于DEA-Malmquist模型,测度1999~2018年的地方医疗卫生财政支出效率,整体来看20年间地方医疗卫生财政支出效率呈下降趋势,且技术进步效率是主导因素,2003年SARS危机与2009年新医改的外来冲击明显提升地方医疗卫生财政支出效率,且纯技术效率、技术进步效率提升分别是主导因素。利用面板数据Tobit回归模型,实证检验财政分权、医疗卫生体制改革对地方医疗卫生财政支出效率的影响机制,研究发现:财政分权显著提升了地方医疗卫生财政支出水平,但却降低了地方医疗卫生财政支出规模效率;财政分权显著降低了地方医疗卫生财政支出纯技术效率,但应对突发公共卫生事件缓释了该作用;医疗卫生体制改革显著提升了地方医疗卫生财政支出技术进步效率,并促进了财政分权对地方医疗卫生财政支出技术进步效率的提升作用。基于此建议,进一步深化医疗卫生体制改革,提高技术进步效率;建立内嵌健康管理能力的政绩考核机制,弱化财政分权对纯技术效率的影响;精准划分医疗卫生领域事权和支出责任,提升地方医疗卫生支出的规模效率。
Improving the efficiency of medical and health financial expenditure is an important guarantee for comprehensively promoting the construction of healthy China and implementing the strategy of“facing people’s life and health”,and it is also an important basis for improving health human capital.Based on the DEA Malmquist model,this paper measures the efficiency of local medical and health expenditure from 1999 to 2018.On the whole,the efficiency of local medical and health expenditure shows a downward trend in the past 20 years,and the efficiency of technological progress is the leading factor.The SARS crisis in 2003 and the external impact of the new medical reform in 2009 significantly improve the efficiency of local medical and health expenditure,and the pure technical efficiency Technological progress and efficiency improvement are the leading factors.Using the Tobit regression model of panel data,this paper empirically tests the influence mechanism of fiscal decentralization and health care system reform on the efficiency of local health care fiscal expenditure.The results show that fiscal decentralization significantly improves the level of local health care fiscal expenditure,but reduces the scale efficiency of local health care fiscal expenditure;Fiscal decentralization significantly reduces the pure technical efficiency of local medical and health expenditure,but alleviates this effect in response to public health emergencies;The medical and health system reform has significantly improved the technical progress efficiency of local medical and health expenditure,and promoted the role of fiscal decentralization in improving the technical progress efficiency of local medical and health expenditure.Based on this suggestion,we should further deepen the reform of medical and health system and improve the efficiency of technological progress;Establish the performance evaluation mechanism with embedded health management ability to weaken the impact of fiscal decentralization on pure technical efficiency;We should accurately divide the powers and expenditure responsibilities in the medical and health field,and improve the scale efficiency of local medical and health expenditure.
作者
赵洪波
姚天歌
刘双双
Zhao Hongbo;Yao TianGe;Liu Shuangshuang
出处
《劳动经济评论》
2021年第2期144-161,共18页
Labor Economic Review
关键词
健康人力资本
医疗卫生财政支出效率
财政分权
医疗卫生体制改革
health human capital
efficiency of medical and health expenditure
fiscal decentralization medical
health system reform
作者简介
赵洪波,山东大学商学院博士研究生;姚天歌,山东大学劳动经济与人力资源研究中心科研助理;通讯作者:刘双双,江苏省社科联助理研究员,E-mail:1050651719@qq.com
