| Although China’s Primary Health Care Services(PHCS)has been fully developed under the background of "strengthen primary health care" in the new medical reform,the problem of "low efficiency" is still very prominent.And under the constraint of limited primary health care resources,the development relying solely on resource input is not sustainable.To study the driving force of the development of PHCS from the perspective of efficiency,explore the influencing factors of the efficiency of primary medical and health service,which is of great significance to further deepen the reform of medical and health system and promote the high-quality development of PHCS.In this study,based on the theory of resource allocation and public service supply,an analysis framework of influencing factors of "horizontal competition-vertical siphon-institutional arrangement-government input" is constructed.Then,based on the DEA-BCC model and DEA-Malmquist index model.the static efficiency and dynamic efficiency of PHCS in 30 provinces(autonomous regions and municipalities directly under the Central Government)during 2010-2020 were measured,and the regional division method of eight comprehensive economic zones was used.The measurement results of service efficiency were compared and analyzed in time and regional dimensions.Finally,the Tobit regression model was used to carry out an empirical study on the factors affecting the efficiency of PHCS.Main conclusions of this study:(1)From the static efficiency dimension,the comprehensive efficiency of PHCS is not high.From 2010 to 2020,the scale efficiency is always higher than the pure technical efficiency.The low comprehensive efficiency is mainly due to the low pure technical efficiency.(2)From the dynamic efficiency dimension,the total factor productivity of PHCS in China maintained negative growth,with an average annual decline of 2.1%,and showed the periodicitydriven characteristics of the system.There was little difference in the decline rate of total factor productivity between the eight comprehensive economic zones,and the overall pattern was high in the east and low in the west.(3)In terms of influencing factors of the efficiency of PHCS,there is an "inverted U-shaped" nonlinear relationship between the horizontal competition degree and the efficiency of PHCS.Too small or too large competition degree is not conducive to the improvement of efficiency.The vertical siphon effect has a significant negative effect on the efficiency of PHCS.The more tertiary or secondary hospitals per 10,0000 people in the province,the lower the efficiency of PHCS in the province.The investment scale of primary medical and health personnel significantly inhibited the improvement of efficiency,while the input quality of health personnel significantly promoted the improvement of efficiency.It can be seen that relying solely on the input scale of primary medical and health personnel can not improve the efficiency of grass-roots medical and health services,and only on the basis of improving the input quality of primary health personnel can the efficiency be improved.In order to comprehensively improve the efficiency of Chinese PHCS,this study puts forward the following suggestions:(1)To further deepen the reform of China’s health care and improve the design of the top-level system related to "Strong Grassroots".(2)Optimize the allocation of primary medical and health resources in each region,so as to narrow the regional differences in primary medical and health resources and efficiency.(3)Each region should appropriately set the marketization degree of PHCS,and be alert to the damage of excessive competition or insufficient competition to the efficiency of PHCS.(4)We should continue to promote the sinking of high-quality medical resources,narrow the level gap between PHCS,and reduce the damage of siphon effect on the efficiency of PHCS.(5)We should pay attention to the input quality of medical resources,so as to improve the efficiency of China’s PHCS. |
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