基于DEA方法的地方政府医疗卫生支出效率实证研究
发布时间：2018-07-29 13:20
【摘要】：随着改革开放的不断推进,在过去的三十多年间,我国政府医疗卫生支出中个人承担的部分经历了大幅度的增长,“看病贵、看病难”问题已经成为发展医疗卫生事业的一大顽疾。2009年3月,中共中央国务院出台了关于《深化医药卫生体制改革的意见》提出“逐步实现人人享有基本医疗卫生服务”的总目标。2011年3月颁布的十二五规划纲要指出,要逐步扩大政府医疗卫生投入,基本医疗卫生支出将被作为一项公共产品向全体社会公众提供。2012年党的十八大报告明确提出“完善旨在提高国民健康水平的相关政策,致力于为社会公众提供安全、有效、方便、价廉的公共卫生产品以及基本医疗卫生服务”。 我国政府在医疗卫生领域的投入规模不断增加。从长远来看,这种支出规模的增长必定是有限的。与此同时,在财政收入方面又具有有限性,两者的矛盾是否有效得到解决将在很大程度上影响我国未来医疗卫生事业的发展。据此,国家卫生部门强调我们不能单纯的只依靠扩大政府医疗卫生投入规模来发展医疗卫生事业,而需要更加的注重效率。在此背景下,本文借助DEA方法对我国的地方政府医疗卫生支出效率进行了实证研究。 全文共有四个章节,可以总结概括为以下三个主要部分： 第一部分：实证的理论依据 主要界定了政府医疗卫生支出效率研究相关的几个重要概念,同时分别从供给、需求、技术进步三个角度阐述了经济增长与政府医疗卫生支出效率之间的关系。该部分属于理论性研究部分。 第二部分：展开实证研究以及总结实证结果 作为本文的核心部分,该部分尝试利用DEA方法中的CCR和BCC模型以及Malmquist生产率指数基于截面数据和面板数据对我国31个省、自治区、直辖市2007—2011年5年间的政府医疗卫生支出效率进行测算,并且就DEA测算的结果对31个地方政府分别从静态和动态的角度以及地域横截面和时间序列两个维度上进行比较分析。 实证研究得出的结论如下： (一)整体支出效率较高但大多未达到最优支出规模 在2011年这一时间点上我国各地方政府的医疗卫生支出效率相对较高,但大多并未达到最优投入规模,有部分地方政府的支出效率距离技术有效还有很大一段距离,另有10个地方政府出现投入冗余,超出最优投入规模,出现卫生资源利用效率不高的现象。 (二)时间序列上支出效率总体上呈上升趋势 2007—-2011年5年间,从时间序列上看,各地方政府的政府医疗卫生支出效率总体呈上升趋势,只是在2009年有微小的下降波动。 (三)横向区域间东部的综合技术效率要高于中、西部地区 一方面是由于纯技术效率高于中、西部地区,另一方面是由于规模报酬效率也高于中、西部地区。 (四)存在投入冗余以及技术和规模效率同时非有效的现象 北京和浙江在5年间的规模报酬持续出现递减,说明其现有的投入规模已经超过了其最优目标规模,加剧了综合技术效率非有效,甚至低下。中、西部的大部分地方存在着既“技术非有效”又“规模非有效”,也就是同时存在着政府医疗卫生资源投入的技术低效率又存在投入规模偏小的问题。 (五)综合技术效率变动整体呈上升趋势但技术水平变动不稳定 借助Malmquist生产率指数动态分析发现,综合技术效率变动整体呈上升趋势,虽有增有减,但增减波动不大,变化比较平稳；五年间的技术水平整体小幅度下降,经历了先平稳、后突增、再降温的三个阶段；五年间的全要素生产率整体小幅度下降,其变动趋势和技术水平的变化趋势基本保持一致,由此可见,全要素生产率的波动变化主要来源于技术变动的不稳定。 第三部分：针对实证结果提出改善问题的对策 在实证研究得出的研究结论基础之上,有针对性的提出了改善我国地方政府医疗卫生支出效率的五点政策性建议。 本文的主要特色和创新点： (一)以完整的全国31个地方政府作为实证研究对象,在指标评价体系的构建上,以经济性、效率性和有效性为基础,把投入要素划分为人力资本投入、物力资本投入、资金投入,投入和产出变量又从政府卫生投入、卫生服务利用率、卫生服务水平三个角度细分,以保证效率评价结果的可靠性。 (二)在研究方法上,地域横截面比较和纵向时间序列分析相结合；此外,以面板数据为基础在静态研究的基础上向动态研究方向延伸,把DEA方法的BBC、 CCR模型分析以及Malmquist生产率指数分析相结合,突破了传统的以静态分析为主的惯例。
[Abstract]:With the continuous promotion of reform and opening up, in the past more than 30 years, the government health expenditure of our government has experienced a substantial increase. "The cost of seeing a doctor and the difficulty of seeing a doctor" has become a major disease in the development of medical and health services in March. The central Committee of the Communist Party of China promulgated the "deepening medical and health body" in March. The general goal of "realizing the basic medical and health service for everyone gradually" in March.2011, which was promulgated in March, pointed out that the government's medical and health investment should be gradually expanded. The basic medical and health expenditure will be provided as a public product to the public to provide the eighteen major reports of the party in the year.2012. "To improve the relevant policies aimed at improving the level of national health and to provide the public with safe, effective, convenient, inexpensive public health products and basic health services".
In the long run, the increase in the scale of expenditure is bound to be limited. At the same time, the financial income is limited. The effective solution of the contradiction will greatly affect the development of the future medical and health services in China. The Department of birth stressed that we can not simply expand the scale of medical and health investment to develop medical and health services, but should pay more attention to efficiency. In this context, this paper has carried out an empirical study on the efficiency of local government health expenditure in China with the help of the DEA method.
There are four chapters in this paper, which can be summarized into three main parts.
The first part: the theoretical basis of the demonstration
This paper mainly defines several important concepts related to the study of the efficiency of government health expenditure, and expounds the relationship between economic growth and the efficiency of government health expenditure from three angles of supply, demand and technological progress. This part belongs to the theoretical research part.
The second part: Empirical Research and summary of empirical results.
As the core part of this paper, this part attempts to use the CCR and BCC models in the DEA method and the Malmquist productivity index based on cross section data and panel data to calculate the government health expenditure efficiency of 31 provinces, autonomous regions and municipalities directly under the central government from 2007 to 2011, and to calculate the results of DEA to 31 local governments, respectively. A comparative analysis was made from two dimensions: static and dynamic, and cross sectional and time series.
The conclusions of the empirical study are as follows:
(1) overall expenditure efficiency is high, but most of them do not reach the optimal scale of expenditure.
In 2011, the efficiency of medical and health expenditure of local governments in China was relatively high, but most of them did not reach the optimal investment scale. Some local governments have a long distance from the efficiency of expenditure, and there are 10 other local governments that have been put into redundant investment, exceeding the optimal investment scale, and the utilization of health resources. A phenomenon of low efficiency.
(two) the overall efficiency of expenditure on the time series is on the rise.
2007 - -2011 5 years, from the time series, the overall efficiency of government health expenditure in various local governments was on the rise, only a slight decline in 2009.
(three) the comprehensive technical efficiency in the eastern part of the horizontal region is higher than that in the central and western regions.
On the one hand, the pure technical efficiency is higher than that of the middle and western regions. On the other hand, the efficiency of scale returns is higher than that of the central and western regions.
(four) there is a phenomenon of redundant investment and inefficient technology and scale efficiency.
In the past 5 years, Beijing and Zhejiang continued to decline in scale, indicating that their existing investment scale has exceeded its optimal target scale, which has exacerbated the inefficiency and even low of the comprehensive technical efficiency. In most parts of the west, there are both "technical non effective" and "non effective", that is, the existence of government medical treatment at the same time. The low efficiency of health resources input also has a small investment scale.
(five) overall technical efficiency change is on the rise, but the level of technological change is unstable.
With the help of the Malmquist productivity index dynamic analysis, it is found that the overall technical efficiency changes are on the rise, although there is an increase and decrease, but the fluctuation is less and more stable. The overall technical level of the five years has fallen slightly, and experienced a stable first, a sudden increase, and another three stages of cooling; the overall factor productivity of the five years is small. The change trend of the change trend is basically consistent with the technological level, so it can be seen that the fluctuation of total factor productivity mainly comes from the instability of the technological change.
The third part: Aiming at the empirical results, put forward the countermeasures to improve the problems.
On the basis of the conclusions drawn from the empirical study, five policy recommendations for improving the efficiency of local government health care expenditure are put forward.
The main features and innovation points of this article are:
(1) taking the 31 local governments in the whole country as an empirical study, on the basis of the construction of the index evaluation system, the input elements are divided into human capital input, material capital input, capital input, investment and output variable from government health input, health service utilization rate and health service on the basis of economic, efficiency and effectiveness. The level is divided into three angles to ensure the reliability of efficiency evaluation results.
(two) in the research method, the regional cross section comparison and the longitudinal time series analysis are combined. In addition, on the basis of the panel data, it extends to the dynamic research direction on the basis of static research, and combines the BBC, CCR model analysis and the Malmquist productivity index analysis of the DEA method, breaking through the traditional static analysis based practice.
【学位授予单位】：江西财经大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：D922.16
本文编号：2152802
[Abstract]:With the continuous promotion of reform and opening up, in the past more than 30 years, the government health expenditure of our government has experienced a substantial increase. "The cost of seeing a doctor and the difficulty of seeing a doctor" has become a major disease in the development of medical and health services in March. The central Committee of the Communist Party of China promulgated the "deepening medical and health body" in March. The general goal of "realizing the basic medical and health service for everyone gradually" in March.2011, which was promulgated in March, pointed out that the government's medical and health investment should be gradually expanded. The basic medical and health expenditure will be provided as a public product to the public to provide the eighteen major reports of the party in the year.2012. "To improve the relevant policies aimed at improving the level of national health and to provide the public with safe, effective, convenient, inexpensive public health products and basic health services".
In the long run, the increase in the scale of expenditure is bound to be limited. At the same time, the financial income is limited. The effective solution of the contradiction will greatly affect the development of the future medical and health services in China. The Department of birth stressed that we can not simply expand the scale of medical and health investment to develop medical and health services, but should pay more attention to efficiency. In this context, this paper has carried out an empirical study on the efficiency of local government health expenditure in China with the help of the DEA method.
There are four chapters in this paper, which can be summarized into three main parts.
The first part: the theoretical basis of the demonstration
This paper mainly defines several important concepts related to the study of the efficiency of government health expenditure, and expounds the relationship between economic growth and the efficiency of government health expenditure from three angles of supply, demand and technological progress. This part belongs to the theoretical research part.
The second part: Empirical Research and summary of empirical results.
As the core part of this paper, this part attempts to use the CCR and BCC models in the DEA method and the Malmquist productivity index based on cross section data and panel data to calculate the government health expenditure efficiency of 31 provinces, autonomous regions and municipalities directly under the central government from 2007 to 2011, and to calculate the results of DEA to 31 local governments, respectively. A comparative analysis was made from two dimensions: static and dynamic, and cross sectional and time series.
The conclusions of the empirical study are as follows:
(1) overall expenditure efficiency is high, but most of them do not reach the optimal scale of expenditure.
In 2011, the efficiency of medical and health expenditure of local governments in China was relatively high, but most of them did not reach the optimal investment scale. Some local governments have a long distance from the efficiency of expenditure, and there are 10 other local governments that have been put into redundant investment, exceeding the optimal investment scale, and the utilization of health resources. A phenomenon of low efficiency.
(two) the overall efficiency of expenditure on the time series is on the rise.
2007 - -2011 5 years, from the time series, the overall efficiency of government health expenditure in various local governments was on the rise, only a slight decline in 2009.
(three) the comprehensive technical efficiency in the eastern part of the horizontal region is higher than that in the central and western regions.
On the one hand, the pure technical efficiency is higher than that of the middle and western regions. On the other hand, the efficiency of scale returns is higher than that of the central and western regions.
(four) there is a phenomenon of redundant investment and inefficient technology and scale efficiency.
In the past 5 years, Beijing and Zhejiang continued to decline in scale, indicating that their existing investment scale has exceeded its optimal target scale, which has exacerbated the inefficiency and even low of the comprehensive technical efficiency. In most parts of the west, there are both "technical non effective" and "non effective", that is, the existence of government medical treatment at the same time. The low efficiency of health resources input also has a small investment scale.
(five) overall technical efficiency change is on the rise, but the level of technological change is unstable.
With the help of the Malmquist productivity index dynamic analysis, it is found that the overall technical efficiency changes are on the rise, although there is an increase and decrease, but the fluctuation is less and more stable. The overall technical level of the five years has fallen slightly, and experienced a stable first, a sudden increase, and another three stages of cooling; the overall factor productivity of the five years is small. The change trend of the change trend is basically consistent with the technological level, so it can be seen that the fluctuation of total factor productivity mainly comes from the instability of the technological change.
The third part: Aiming at the empirical results, put forward the countermeasures to improve the problems.
On the basis of the conclusions drawn from the empirical study, five policy recommendations for improving the efficiency of local government health care expenditure are put forward.
The main features and innovation points of this article are:
(1) taking the 31 local governments in the whole country as an empirical study, on the basis of the construction of the index evaluation system, the input elements are divided into human capital input, material capital input, capital input, investment and output variable from government health input, health service utilization rate and health service on the basis of economic, efficiency and effectiveness. The level is divided into three angles to ensure the reliability of efficiency evaluation results.
(two) in the research method, the regional cross section comparison and the longitudinal time series analysis are combined. In addition, on the basis of the panel data, it extends to the dynamic research direction on the basis of static research, and combines the BBC, CCR model analysis and the Malmquist productivity index analysis of the DEA method, breaking through the traditional static analysis based practice.
【学位授予单位】：江西财经大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：D922.16
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