摘要
目的:厘清地方政府竞争与公共卫生服务供给效率间的关系,并探究二者的传导路径、外部环境与第三变量影响下的阶段波动。方法:利用中国省级多期面板数据,依托DEA-Malmquist模型测算公共卫生服务供给效率,通过工具变量Tobit模型考察新医改后地方政府竞争对公共卫生服务供给效率的影响。结论:(1)适度的为健康而竞争可以提升公共卫生服务供给效率。(2)这种促进效应存在提高“政府财政支配实力”与助推“产业结构转型升级”两条路径,并会伴随“政策环境”的改善而增强。(3)这种促进效应呈现非线性特征,会伴随财政收入累加与城镇化水平提高而持续增强,伴随财政自主性的提高而减弱,伴随人口的集聚存在短暂“无效区间”。建议:地方政府应通过技术嵌入、财政支持、产业优化的方式以促进公共卫生服务供给效率的提升;中央政府则应采取政策引导、绩效考核、监督评价等措施以鼓励适度的“为健康而竞争”。
Objective:This paper is to clarify the relationship between local government competition and the efficiency of healthcare service supply,and explore the stage fluctuations under the influence of the conduction path,external environment,and third variables.Methods:This paper calculates efficiency of public health service supply by utilizing multi-period panel data at the provincial level in China,relying on the DEA-Malmquist model,and the influence of local government competition on the public health service supply efficiency after investigating the new healthcare system reform by the instrumental variable Tobit model.Conclusions:(1)Moderate competition for health can enhance the efficiency of medical and health service provision.(2)This promoting effect occurs through two pathways:improving the“government s financial dominance strength”and promoting“industrial structure transformation and upgrading”.Moreover,it is enhanced with the improvement of the“policy environment”.(3)This promoting effect exhibits nonlinear characteristics,which continuously increases with the accumulation of fiscal revenue and the increase of urbanization levels,weakens with increased fiscal autonomy,and has a short-term“ineffective interval”with population agglomeration.Suggestions:Local governments should adopt technology embedment,financial support and industrial optimization.The central government should strengthen policy guidance,performance appraisal,supervision and evaluation.
作者
孔凡懿
王鸿蕴
KONG Fan-yi;WANG Hong-yun(Institute for Hospital Management of Tsinghua University,Shenzhen Guangdong 518055,China;School of Management,Beijing University of Chinese Medicine,Beijing 100029,China)
出处
《中国卫生政策研究》
CSCD
北大核心
2023年第10期26-34,共9页
Chinese Journal of Health Policy
基金
国家中医药管理局项目(BUCM-2021-KJ-GL015)。
关键词
地方政府竞争
公共卫生服务
供给效率
新医改
Local government competition
Public health service
Supply efficiency
New healthcare system reform
