基于DEA方法的地方政府醫(yī)療衛(wèi)生支出效率實(shí)證研究
發(fā)布時(shí)間：2018-07-29 13:20
【摘要】：隨著改革開放的不斷推進(jìn),在過去的三十多年間,我國政府醫(yī)療衛(wèi)生支出中個(gè)人承擔(dān)的部分經(jīng)歷了大幅度的增長,“看病貴、看病難”問題已經(jīng)成為發(fā)展醫(yī)療衛(wèi)生事業(yè)的一大頑疾。2009年3月,中共中央國務(wù)院出臺(tái)了關(guān)于《深化醫(yī)藥衛(wèi)生體制改革的意見》提出“逐步實(shí)現(xiàn)人人享有基本醫(yī)療衛(wèi)生服務(wù)”的總目標(biāo)。2011年3月頒布的十二五規(guī)劃綱要指出,要逐步擴(kuò)大政府醫(yī)療衛(wèi)生投入,基本醫(yī)療衛(wèi)生支出將被作為一項(xiàng)公共產(chǎn)品向全體社會(huì)公眾提供。2012年黨的十八大報(bào)告明確提出“完善旨在提高國民健康水平的相關(guān)政策,致力于為社會(huì)公眾提供安全、有效、方便、價(jià)廉的公共衛(wèi)生產(chǎn)品以及基本醫(yī)療衛(wèi)生服務(wù)”。 我國政府在醫(yī)療衛(wèi)生領(lǐng)域的投入規(guī)模不斷增加。從長遠(yuǎn)來看,這種支出規(guī)模的增長必定是有限的。與此同時(shí),在財(cái)政收入方面又具有有限性,兩者的矛盾是否有效得到解決將在很大程度上影響我國未來醫(yī)療衛(wèi)生事業(yè)的發(fā)展。據(jù)此,國家衛(wèi)生部門強(qiáng)調(diào)我們不能單純的只依靠擴(kuò)大政府醫(yī)療衛(wèi)生投入規(guī)模來發(fā)展醫(yī)療衛(wèi)生事業(yè),而需要更加的注重效率。在此背景下,本文借助DEA方法對(duì)我國的地方政府醫(yī)療衛(wèi)生支出效率進(jìn)行了實(shí)證研究。 全文共有四個(gè)章節(jié),可以總結(jié)概括為以下三個(gè)主要部分： 第一部分：實(shí)證的理論依據(jù) 主要界定了政府醫(yī)療衛(wèi)生支出效率研究相關(guān)的幾個(gè)重要概念,同時(shí)分別從供給、需求、技術(shù)進(jìn)步三個(gè)角度闡述了經(jīng)濟(jì)增長與政府醫(yī)療衛(wèi)生支出效率之間的關(guān)系。該部分屬于理論性研究部分。 第二部分：展開實(shí)證研究以及總結(jié)實(shí)證結(jié)果 作為本文的核心部分,該部分嘗試?yán)肈EA方法中的CCR和BCC模型以及Malmquist生產(chǎn)率指數(shù)基于截面數(shù)據(jù)和面板數(shù)據(jù)對(duì)我國31個(gè)省、自治區(qū)、直轄市2007—2011年5年間的政府醫(yī)療衛(wèi)生支出效率進(jìn)行測(cè)算,并且就DEA測(cè)算的結(jié)果對(duì)31個(gè)地方政府分別從靜態(tài)和動(dòng)態(tài)的角度以及地域橫截面和時(shí)間序列兩個(gè)維度上進(jìn)行比較分析。 實(shí)證研究得出的結(jié)論如下： (一)整體支出效率較高但大多未達(dá)到最優(yōu)支出規(guī)模 在2011年這一時(shí)間點(diǎn)上我國各地方政府的醫(yī)療衛(wèi)生支出效率相對(duì)較高,但大多并未達(dá)到最優(yōu)投入規(guī)模,有部分地方政府的支出效率距離技術(shù)有效還有很大一段距離,另有10個(gè)地方政府出現(xiàn)投入冗余,超出最優(yōu)投入規(guī)模,出現(xiàn)衛(wèi)生資源利用效率不高的現(xiàn)象。 (二)時(shí)間序列上支出效率總體上呈上升趨勢(shì) 2007—-2011年5年間,從時(shí)間序列上看,各地方政府的政府醫(yī)療衛(wèi)生支出效率總體呈上升趨勢(shì),只是在2009年有微小的下降波動(dòng)。 (三)橫向區(qū)域間東部的綜合技術(shù)效率要高于中、西部地區(qū) 一方面是由于純技術(shù)效率高于中、西部地區(qū),另一方面是由于規(guī)模報(bào)酬效率也高于中、西部地區(qū)。 (四)存在投入冗余以及技術(shù)和規(guī)模效率同時(shí)非有效的現(xiàn)象 北京和浙江在5年間的規(guī)模報(bào)酬持續(xù)出現(xiàn)遞減,說明其現(xiàn)有的投入規(guī)模已經(jīng)超過了其最優(yōu)目標(biāo)規(guī)模,加劇了綜合技術(shù)效率非有效,甚至低下。中、西部的大部分地方存在著既“技術(shù)非有效”又“規(guī)模非有效”,也就是同時(shí)存在著政府醫(yī)療衛(wèi)生資源投入的技術(shù)低效率又存在投入規(guī)模偏小的問題。 (五)綜合技術(shù)效率變動(dòng)整體呈上升趨勢(shì)但技術(shù)水平變動(dòng)不穩(wěn)定 借助Malmquist生產(chǎn)率指數(shù)動(dòng)態(tài)分析發(fā)現(xiàn),綜合技術(shù)效率變動(dòng)整體呈上升趨勢(shì),雖有增有減,但增減波動(dòng)不大,變化比較平穩(wěn)；五年間的技術(shù)水平整體小幅度下降,經(jīng)歷了先平穩(wěn)、后突增、再降溫的三個(gè)階段；五年間的全要素生產(chǎn)率整體小幅度下降,其變動(dòng)趨勢(shì)和技術(shù)水平的變化趨勢(shì)基本保持一致,由此可見,全要素生產(chǎn)率的波動(dòng)變化主要來源于技術(shù)變動(dòng)的不穩(wěn)定。 第三部分：針對(duì)實(shí)證結(jié)果提出改善問題的對(duì)策 在實(shí)證研究得出的研究結(jié)論基礎(chǔ)之上,有針對(duì)性的提出了改善我國地方政府醫(yī)療衛(wèi)生支出效率的五點(diǎn)政策性建議。 本文的主要特色和創(chuàng)新點(diǎn)： (一)以完整的全國31個(gè)地方政府作為實(shí)證研究對(duì)象,在指標(biāo)評(píng)價(jià)體系的構(gòu)建上,以經(jīng)濟(jì)性、效率性和有效性為基礎(chǔ),把投入要素劃分為人力資本投入、物力資本投入、資金投入,投入和產(chǎn)出變量又從政府衛(wèi)生投入、衛(wèi)生服務(wù)利用率、衛(wèi)生服務(wù)水平三個(gè)角度細(xì)分,以保證效率評(píng)價(jià)結(jié)果的可靠性。 (二)在研究方法上,地域橫截面比較和縱向時(shí)間序列分析相結(jié)合；此外,以面板數(shù)據(jù)為基礎(chǔ)在靜態(tài)研究的基礎(chǔ)上向動(dòng)態(tài)研究方向延伸,把DEA方法的BBC、 CCR模型分析以及Malmquist生產(chǎn)率指數(shù)分析相結(jié)合,突破了傳統(tǒng)的以靜態(tài)分析為主的慣例。
[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.
【學(xué)位授予單位】：江西財(cái)經(jīng)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：D922.16
本文編號(hào)：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.
【學(xué)位授予單位】：江西財(cái)經(jīng)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：D922.16
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，本文編號(hào)：2152802
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