| In recent years,with the continuous development of China’s medical and health system reform,the reform of medical and health undertakings in various places has achieved remarkable results,and China has built the largest medical and health system in the world.However,from the perspective of balanced development,due to the influence of social and economic environment,management mechanism,financial funds,health technical personnel and other factors,the defects and deficiencies in the development process of primary medical and health services are still prominent.In 2023,the first document of the Central Committee proposed that the most arduous task of building a modern socialist country in an all-round way is still in the countryside.In some rural areas,there are smaller village doctors,older equipment,limited health service ability and serious talent team.The serious shortage of reserve medical personnel has resulted in weak medical and health services in some rural areas,and the health level of local rural residents is far lower than that of urban residents.Statistics in 2020 show that the number of health technicians and beds per 1,000 people in urban areas is 11.46 and 8.81,while that in rural areas is only 5.18 and 4.95.The gap in the allocation of medical and health resources is particularly visible between urban and rural areas.Therefore,it is urgent to take rural medical and health undertakings as the priority among priorities in the development of the whole medical and health undertakings.In addition,China is still in the stage of linking the achievements of poverty alleviation and rural revitalization.The Outline of the Healthy China 2030 Plan also emphasizes the importance of focusing on rural areas and the community level,and promoting equal access to basic public services in the field of health.Therefore,based on this background,it is of great theoretical and practical significance to study the statistical measurement and influencing factors of rural basic medical and health service level for the government to formulate financial fund plan,macro-control medical and health resources,improve the efficiency of existing resources allocation,and promote the rapid and better development of rural medical and health service.In view of this,this thesis firstly sorted out the concept of "basic medical and health service",summarized the basic concept of rural basic medical and health service,and started from infrastructure,human resources,capital investment and service efficiency.This thesis selected 12 sub-indexes and 14 basic indexes to construct the evaluation index system of rural basic medical and health service level.Secondly,the panel data of 29 provinces,municipalities and autonomous regions from 2010 to 2020 were used to further measure the level of rural basic medical and health services in each region by assigning weights to each index by means of vertical and horizontal splitting method.Then,the kernel density estimation method was used for time evolution analysis,the natural fracture method and Arc GIS software were used for spatial visualization analysis,Moran’s I index was used for spatial correlation analysis,and the Theil index and its decomposition were used to explore the inter-regional and intra-regional heterogeneity.Finally,by using the Bayesian model average and spatial econometric model,the thesis explores which of the 16 popular influencing factors are the important influencing factors of the level of rural basic medical and health services.The main research conclusions are summarized as follows:(1)From 2010 to 2020,the level of rural basic medical and health services in 29 provinces,municipalities and autonomous regions except Tianjin has been steadily improved.Meanwhile,there are great differences in provincial indexes.The overall level of rural basic medical and health services in provinces shows a decreasing trend in the east,central,west and northeast regions.However,the growth rate of rural basic medical and health service level presents a trend of western > central > eastern > northeastern.The level of rural basic medical and health service in western and central regions has a "catch-up effect" to the eastern region,while the level of rural basic medical and health service in northeastern regions is at a low level and lagging behind in the development of all regions.(2)In terms of temporal and spatial evolution,the overall level of rural basic medical and health services has been improving from 2010 to 2020,but the differences among provinces are showing a trend of expanding.Moreover,the distribution of rural basic medical and health services in provinces has experienced a trend of "first deepening polarization and then gradually flattening normal distribution".At the beginning,middle and end of the observation period,the level of rural basic medical and health services showed different agglomeration trends.There is an overall positive correlation in the level of basic medical and health services in rural areas,with a high degree of regional clustering.Most provinces in the west and northeast are in the low level and have not changed in a long time.The main source of the overall difference of rural basic medical and health service level has gradually evolved from inter-regional and intra-regional differences in 2010 to intra-regional differences in 2020.The contribution rate of eastern region is the largest and the fastest,followed by western region,central region is the third and the growth rate is relatively slow,and the northeast region has the least difference.(3)The empirical results show that the output value of the pharmaceutical manufacturing industry,the per capita health care consumption expenditure of rural residents,the child dependency ratio,the elderly support ratio,the urbanization rate,the per capita gross regional product,the per capita disposable income of rural residents,the level of education of rural residents,and the intensity of environmental damage are the important factors affecting the level of rural basic health care.Among them,the development scale of the pharmaceutical manufacturing industry,the per capita medical care expenditure of rural residents,the elderly support ratio,per capita GDP,per capita disposable income of rural residents and the intensity of environmental damage have a significant promoting effect on the level of basic medical and health services in rural areas.The urbanization rate and the education level of rural residents have a significant inhibitory effect on the level of rural basic medical and health services.From the perspective of spatial spillover effect,the level of rural basic medical and health services in this region is affected by the surrounding areas.Finally,according to the theoretical and empirical analysis results,and combined with the actual development of basic medical and health services in rural areas,the following policy recommendations are put forward: firstly,take multiple measures to improve the basic medical and health services level of village clinics in western and northeastern areas.Clarify the nature of village clinics and promote the practice of rural doctors;Provide financial support to improve the infrastructure of village clinics in rural areas;Strengthen the construction of talent team and improve the overall quality of rural doctors.Secondly,give full play to the positive spatial spillover effect and coordinate "market allocation" and "government functions".The government at a higher level shall carry out macro-management and regulation on health and medical resources,and encourage areas with high basic medical and health services to play a helping role in promoting the improvement of basic medical and health services in surrounding areas,so as to achieve balanced development.Meanwhile,government supervision should be strengthened to ensure the public welfare and universal benefits of medical and health services.Thirdly,we need to improve the efficiency of the pharmaceutical manufacturing industry and promote the distribution of medical and health resources to the community.We will expand the scale of the pharmaceutical manufacturing industry,increase the proportion of qualified professionals,strengthen brand and quality development,accelerate the construction of standardized township and village health centers,increase the supply of basic health resources to community-level medical and health institutions in rural areas,and effectively improve the level of basic medical and health services in rural areas. |
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