摘要
目的:揭示医疗资源配置效率的时空分异规律,解析区域差异的驱动机制,为优化健康服务体系提供理论参考与实践借鉴。方法:基于2012—2023年江苏省13个地级市面板数据,构建SBM模型测度医疗资源配置效率,运用Dagum基尼系数分解区域差异来源,结合Tobit模型识别制度性影响因素。结果:江苏省医疗资源配置综合效率均值为0.703,呈现“苏南地区技术低效(PTE=0.735)、苏北地区规模不足(SE=0.956)”的分异特征;区域差异贡献率从超变密度主导(51.07%)转向组间差异主导(72.92%),苏南与苏中地区的组间基尼系数达0.168;人口密度、政府卫生支出、医师工作负荷、人均人员经费与医疗资源配置效率呈负相关;医疗机构负债率、向下转诊率、临床路径管理与效率呈正相关。结论:医疗资源配置失衡存在“梯度锁定”效应,需构建“规模优化-制度创新-区域协同”治理框架,通过分级诊疗制度整合、临床路径标准化建设及跨区域补偿机制,破解效率困境。
Objective To reveal the spatiotemporal differentiation patterns of healthcare resource allocation efficiency,analyze the driving mechanisms of regional disparities.Methods Using panel data from 13 cities in Jiangsu Province from 2012 to 2023,a non-radial SBM model was constructed to measure the efficiency of healthcare resource allocation.The Dagum Gini coefficient decomposition method was applied to identify regional disparity sources,and the Tobit model was employed to identify institutional influencing factors.Results The average comprehensive efficiency of healthcare resource allocation in Jiangsu Province was 0.703,exhibiting a dual-track divergence characterized by"technical inefficiency in southern Jiangsu(PTE=0.735)and scale insufficiency in northern Jiangsu(SE=0.956)".The contribution rate of regional disparities shifted from hypervariable density dominance(51.07%)to inter-group disparity dominance(72.92%),with the inter-group Gini coefficient between southern and central Jiangsu reaching 0.168.Population density,government health expenditure,physician workload,and per capita personnel expenses showed negative correlations with healthcare resource allocation efficiency.Medical institution debt ratios,primary care referral rates,and clinical pathway management demonstrated positive correlations with the efficiency.Conclusion Healthcare resource allocation imbalance exhibits a"gradient lock-in"effect.It is necessary to establish a governance framework integrating"scale optimization,institutional innovation,and regional coordination".By integrating the hierarchical diagnosis and treatment system,standardizing clinical pathways,and implementing cross regional compensation mechanisms,the efficiency dilemma can be solved.
作者
戴涛明
袁洁
戴克思
杨庆芝
DAI Taoming;YUAN Jie;DAI Kexi;YANG Qingzhi(The Sixth Affiliated Hospital of Nantong University,Yancheng Jiangsu 224008,China;不详)
作者简介
通讯作者:杨庆芝,E-mail:yc3ybc@163.com;戴涛明(1996-),男,江苏盐城人,研究员,研究方向:卫生分析与医院管理。
