Research On The Spatial Differentiation And Driving Factors Of Coupling Coordination Development Of Rural Medical Health Service And Economy

Objectives:First,this study identifies the coupling mechanism between rural health care services and rural economy in China,and measures the development index values and coupling coordination degree of rural health services and rural economy by constructing an evaluation index system of rural health services and rural economy.Secondly,based on the coupling and coordination theory,a coupling and coordination degree model is constructed to analyze the evaluation index values of the two systems and their increases,the evaluation index values of each dimension of the index system,the comprehensive evaluation index,the coupling degree and the coupling and coordination degree in the evolution state in time and the spatial differentiation pattern;based on spatial statistical theory and spatial econometric theory,the spatial correlation and clustering characteristics of the coupling and coordination degree of each provincial administrative region are further analyzed.Finally,the driving factors of the coupled and coordinated development of rural medical and health services and rural economy are explored,and the spatial econometric model is used to analyze the driving factors affecting the coordinated development of the system.Methods:（1）Literature review method.To sort out the conceptual connotation,theoretical basis,current research status,role relationship and coupled and coordinated development of rural health services and rural economy.（2）Panel discussion method.To explore the evaluation index system of rural medical and health services and rural economy and the driving factors of the coordinated development of rural medical and health services and rural economy.（3）Empirical statistical analysis method.The Coupled coordination model was constructed to measure the development index and coupling coordination degree of the two systems.The data of each index was standardized using SPSS 24.0,and the evaluation index value and coupling coordination degree were calculated using Excel 2019.The spatial distribution map was drawn using Arc GIS 10.7 software,and the spatial autocorrelation analysis of the two systems’coordination degree was performed using Geo Da software.A spatial econometric model was constructed,and the Geo Da software was used to analyze the driving factors of the coordinated development of rural health services and rural economy.Results:（1）Construction of the evaluation index system of rural medical health services and rural economyThe evaluation indexes system of rural medical health services consists of 3primary indicators and 11 secondary indicators,while the evaluation indexes system of rural economy consist of 3 primary indicators and 9 secondary indicators.（2）Analysis of the evaluation index values of rural medical health services and rural economyAnalysis from the time perspective:（1）The value of the evaluation index of rural medical health services is between[0.215,0.364].From 2009 to 2013,the value increased from 0.215 to 0.280 with a growth rate between[4.76%,7.69%];from 2014to 2020,it increased from 0.29 to 0.364 in 2019,8.98%in 2019 and with a value of0.356 in 2020.The evaluation index value of the service input dimension in the indicator system changed from 0.123 to 0.208;the service process dimension ranged between[0.074,0.136];and the service outcome dimension was mostly 0.018 and 0.017.（2）The value of the rural economic evaluation index is between[0.166,0.439].Between2009 and 2013,the value changed from 0.166 to 0.289 with a growth rate between[12.02%,18.56%],with a growth rate of 18.56%in 2011;between 2014 and 2020,the value changed from 0.313 to 0.439,with a growth rate of 8.53%in 2019.The value of the evaluation index of the economic level dimension of the rural economy evaluation index system increased from 0.069 to 0.147;the production level dimension ranged from[0.053,0.069];the living level dimension increased from 0.044 to 0.223.Analysis from the spatial perspective:（1）From 2009 to 2020,the average values of the evaluation index of rural medical health services in the east,central,west and northeast regions are 0.362,0.360,0.234 and 0.203,respectively.From the viewpoint of provincial administrative regions,the results for four provincial administrative regions,Shandong Province,Jiangsu Province,Henan Province and Sichuan Province,lie between[0.464,0.567]and are the darkest in the spatial distribution.The results of Tibet Autonomous Region,Qinghai Province,Gansu Province,Ningxia Hui,Autono-mous Region,Inner Mongolia Autonomous Region,Jiangxi Province,Hainan Province,Heilongjiang Province and Jilin Province are between[0.083,0.202],with a lighter color in the spatial distribution,while the value for Tibet Autonomous Region is only0.083.From within each region,the results are 0.188 and 0.202 for Hainan Province and Shanxi Province,respectively,and 0.464 for Sichuan Province;0.212,0.199 and0.197 for Liaoning Province,Jilin Province and Heilongjiang Province,respectively.in the service input dimension of the evaluation index system,the evaluation index values for the four regions of East,Central and West and Northeast are 0.193,0.232,0.130,0.108;in the service process dimension,0.153,0.108,0.086,0.082 in the four regions;in the service result dimension,0.015,0.020,0.018,0.012 in the four regions.（2）From2009 to 2020,the mean values of the rural economic evaluation index in the East,Central and West and Northeast regions are 0.437,0.357,0.218 and 0.284,respectively.from the provincial administrative regions,Shandong Province,Jiangsu Province,Guangdong Province,Zhejiang Province and Henan Province have values between[0.478,0.607]and are the darkest in the distribution chart.The results of Tibet Autonomous Region,Qinghai Province,Gansu Province,Ningxia Hui Autonomous Region,Hainan Province,Guizhou Province and Shanxi Province are between[0.141,0.193]and have lighter colors in the distribution chart,and the value of Gansu Province is only 0.141.From the perspective of each region,the results of Hainan Province and Shanxi Province are 0.181 and 0.193 respectively;the result of Sichuan Province is0.401.In the economic level dimension of the evaluation index system,the evaluation index values of the four regions in the east,central,west and northeast are 0.135,0.137,0.079 and 0.111 respectively;in the production level dimension,the four regions are0.091,0.083,0.045 and 0.046 respectively;in the living standard dimension,the four regions are 0.211,0.137,0.094 and 0.128 respectively,0.083,0.045,0.046 in the production level dimension;and 0.211,0.137,0.094,0.128 in the living level dimension for the four regions.Analysis in terms of the average annual increase of the evaluation index values:（1）In the distribution chart of the average annual increase of rural medical health services,the regions with darker colors are mostly concentrated in the western region.Among them,Ningxia Hui Autonomous Region,Qinghai Province,Xinjiang Uygur Autonomous Region,and Guizhou Province have increases between[6.95%,8.36%],which are high value regions.Tibet Autonomous Region,Shandong Province,Shanxi Province,Guangdong Province,Hebei Province increased between[1.99%,3.45%],is a low value region.（2）In the distribution chart of the annual average growth of rural economy,the western region is darker in color.Among them,Guizhou Province,Yunnan Province,Hainan Province,Gansu Province,Chongqing Municipality,Shaanxi Province and Xinjiang Autonomous Region are in the higher range of growth between[12.19%,17.03%],respectively.Shandong Province,Liaoning Province,Hebei Province,Zhejiang Province,Tianjin City,the increase between[5.79%,7.01%],in the lower range.（3）Analysis of the value of the comprehensive evaluation index of rural medical health services and rural economyAnalyzed from a temporal perspective:the value from 2009 to 2020 increased from 0.190 to 0.398.Analyzed from a spatial perspective:the values in the east,central and west and northeast regions were 0.399,0.359,0.226 and 0.243,respectively.the results in Shandong,Jiangsu and Henan provinces were between[0.513,0.587].The results of Zhejiang,Guangdong,Hunan,Hubei,Hebei,and Sichuan provinces are between[0.395,0.461].The results for the Northeast and the remaining 17 provincial administrative regions in the East,Central,West ranged between[0.124,0.350].（4）Analysis of the coupling coordination between rural medical health services and rural economyAnalysis from the time perspective:the coupling degree is between[0.9917,1.0000].The coupling coordination degree is between[0.435,0.629].The results are divided into three time periods according to the coupling level,from 0.435to 0.486 for 2009 to 2011,from 0.509 to 0.592 for 2012 to 2017,and from 0.600 to0.629 for 2018 to 2020,where the increase from 2009 to 2013 is in the range of 4.72%to 5.75%,and from 2014 to 2020 The increase from 2009 to 2013 is in the range of4.72%to 5.75%and from 2014 to 2020 is in the range of 0.64%to 3.00%.Analysis from the spatial perspective:First,from the evolutionary trend of four time periods.from 2009 to 2011,the mean values of coupling coordination in the four regions of East,Midwest and Northeast were 0.537,0.509,0.381 and 0.410,respectively,and the numbers of dysfunctional,barely coordinated,low coordinated,primary coordinated,intermediate coordinated and good coordinated types in the distribution map were 14,6,6,3,0,0.from 2012 to 2014,the four regions were 0.610,0.578,0.452,0.482,and the number of types were 4,10,6,8,1,0,respectively;between2015 and 2017,the four regions were 0.662,0.624,0.500,0.516,and the number of types were 2,7,10,6,4,and 0;from 2018 to 2020,the four regions are 0.699,0.670,0.547,and 0.539,and the number of types are 1,5,10,5,6,and 2,respectively,with only the Tibet Autonomous Region being in disorder.Second,looking at each provincial administrative region.in 2009 to 2020,the coupling coordination in Tibet Autonomous Region is between[0.219,0.392];Guangdong Province,Zhejiang Province,Jiangsu Province,Shandong Province,Henan Province and Sichuan Province all have darker colors in the distribution map.Hainan Province and Shanxi Province develop from mildly disordered to barely coordinated coordination types,and Sichuan Province jumps to intermediate coordination types.Third,in terms of the relative development of the two systems.the number of health lagging,economic lagging,and synchronous development type in 29 provincial administrative regions were divided into 2,13,and 14 during 2009 to 2011;12,7,and 10 during 2012 to 2014;13,3,and13 during 2015 to 2017;and 17,1,and 11 during 2018 to 2020.17,1,11.In 2009 to2011,the economic lagging type is most obvious in the Midwest,and in 2018 to 2020,the eastern and northeastern regions mostly belong to the health lagging type,and the economic lagging is also only in the western region.（5）Analysis of the spatial autocorrelation of the coupling coordination between rural medical health services and rural economyThe global Moran’s I index values ranged between[0.282,0.365],and all p-values were less than 0.05.In the local autocorrelation analysis,the percentage of Moran’s I scatter plots in the four time periods was 79.31%,72.41%,72.41%,72.41%in the first quadrant and third quadrant,respectively,for the provincial administrative regions,79.31%,and 72.41%.In the LISA clustering diagram of coupling coordination degree,during the period from 2009 to 2020,Shandong Province,Jiangsu Province,and Anhui Province are always in the high-high clustering area,Xinjiang Autonomous Region is in the low-low clustering area,and Sichuan Province is in the high-low clustering area.In the LISA agglomeration diagram of the average annual increase in coupling coordination,the increases in four of these regions are 2.97%,3.28%,4.22%,and3.24%,respectively.（6）Analysis of the drivers of coordinated development of rural medical health services and rural economyIn 2011,the total health cost per capita,the number of rural population,and the number of enrollment in general higher education schools have positive effects on the coordination level,and in 2016 and 2019,the total health cost per capita,the number of rural population,and urbanization have positive effects on the coordination level.Conclusions:（1）The evaluation indexes of the two systems were measured by the constructed evaluation index systems of rural medical health services（f₁）and rural economy（f₂）.（1）On the trend of time evolution:the evaluation indices of both systems show an overall upward trend,and the growth rate of index values from 2009 to 2013 is higher than that from 2014 to 2020.The increase of both systems is larger in 2019,the increase of rural economy is the fastest in 2011,and the index value of rural medical health services decreases in 2020.The combined evaluation index values for both systems are also increasing.（2）In the spatial distribution pattern:the two-system index values and the comprehensive evaluation index values in the east-central region are higher than those in the west and northeast regions.Shandong Province,Jiangsu Province,Henan Province,Sichuan Province and Guangdong Province and Zhejiang Province all have higher values than other provincial administrative regions.The western regions such as Tibet Autonomous Region,Qinghai Province and Gansu Province are all lower than other provincial administrative regions.Hainan Province and Shanxi Province have lower index values compared to other regions in the east-central region.Sichuan Province is in the leading position in the western region.The values of rural medical health services in three provinces in the northeast region are relatively close.The average annual increase in the index values of both systems in the western region is the highest value.（2）The coupling coordination degree of the two systems is measured by the constructed two-system evaluation index system.（1）On the trend of time evolution:the coupling degree belongs to a high level.The coupling coordination degree has been growing,developing from barely coordinated to primary coordination level,with relatively high increase from 2009 to 2013.（2）On the spatial distribution pattern:the coupling coordination type in the east-central region has been ahead of the west and northeast.Guangdong Province,Zhejiang Province,Jiangsu Province,Shandong Province,Henan Province and Sichuan Province have better coupling coordination types.Tibet Autonomous Region has been the dysfunctional type.Hainan Province and Shanxi Province have a smaller span of coordination level.Both systems are mostly economically lagging relative to the middle and early stages of development and mostly distributed in the central and western parts of the country,and the development increases to the later period of health lagging,mostly in the eastern and northeastern parts of the country.（3）Spatial autocorrelation analysis:the coupling coordination of the two systems is clustered in spatial distribution,and mostly belongs to high-high and low-low clusters.Based on the level of coordination,the 29 regions can be classified into three types:high level development,low level development and polarized development.Among them,Shandong Province,Jiangsu Province and Anhui Province have higher values with their neighboring regions,while Xinjiang Autonomous Region has lower values with its neighboring regions,and Sichuan Province has higher values than its neighboring regions.The western region has the fastest increase in coupling coordination.（3）Drivers of coordinated development of rural medical health services and rural economy.The total health cost per capita,the number of rural population,the level of urbanization,and the number of general college and university school enrollment have a positive effect on the coordinated development of the two systems.（4）Suggest countermeasures to promote the coordinated development of rural medical health services and rural economy.（1）Implement precise medical and health care services to improve the utilization rate of residents’resources:pay attention to the health needs of rural residents and protect the health level of the public;effectively implement the graded treatment model to improve the utilization rate of services.（2）Increase the allocation of high-quality resources in rural areas and consolidate the foundation of development in rural areas:keep the bottom line of rural population and boost the return of talents;integrate high-quality resources in urban and rural areas and promote the sinking of resources.（3）Implement construction programs according to local conditions and promote the balanced development of provincial regions:explore the unique development path by tapping its own characteristic advantageous resources;make considerations according to local conditions and promote the coordinated development of the two subsystems;implement assistance and cooperation programs to form regional linkages.