摘要
农村基层医疗资源配置与服务利用耦合协调是衡量乡村健康治理成效的重要向度。实证研究发现:我国农村基层医疗资源配置与服务利用耦合协调水平稳步提升,整体上已从濒临失调进入勉强协调阶段,区域上呈现中部>东部>西部>东北的分布格局。空间相关性分析表明,我国各省(区、市)农村基层医疗资源配置与服务利用耦合协调水平存在正向空间关联特征且集聚效应显著。空间集聚类型以“高—高”和“低—低”集聚为主,前者主要分布在东部和中部,后者则基本稳定在西部与东北。机制分析证明,农村社会保障财政支出和农村数字化水平对农村基层医疗资源配置与服务利用耦合协调具有显著的促进作用,而财政分权与交通基础设施则具有明显的抑制作用。在健康乡村治理场域,应进一步优化农村基层医疗资源配置结构,加强农村基层医疗资源跨域流动与服务协作,同步创新财政补偿机制、探索农村数字健康共同体模式等,充分提升农村基层医疗资源配置与服务利用的耦合协调效能,实现农村医疗卫生体系均衡发展。
The expansion of rural primary health resources and the balanced distribution of regional layout are the essential requirements of a healthy rural construction.However,for a long time,China’s rural areas have been faced with problems like the shortage of primary health resources and insufficient health service capacity,resulting in a low utilization rate of outpatient and inpatient services as well as difficulties in effectively guaranteeing health rights of rural residents.With the accelerating process of population aging and the structural adjustment of disease spectrum,it has become an urgent task to rationally allocate rural primary health resources and realize balanced development of health services among regions.This study adopts the entropy weight method and coupling coordination degree model to measure the coupling coordination relationship between rural primary health resource allocation and service utilization of 29 provinces(autonomous regions and municipalities)in China from 2007 to 2021,and employs spatial autocorrelation analysis and spatial econometric model to explore the spatial deductive characteristics,evolution trends,and driving mechanisms of coupling coordination in rural primary health resource allocation and service utilization.It is found that:(1)since 2007,the coupling coordination relationship between rural primary health resource allocation and service utilization in China has been steadily improved.Overall,it has entered a barely coordinated stage from the initial near-disorder stage.As for regional distribution,it has a pattern of central>eastern>western>northeast.(2)Spatial correlation analysis shows that the coupling coordination relationship exhibits positive spatial association characteristics with significant spatial agglomeration effects.In terms of spatial distribution,it shows characteristics of high-high value agglomeration and low-low value agglomeration,among which high-high value agglomeration areas are mainly distributed in the eastern and central regions,while low-low value agglomeration areas are mainly in the western and northeastern regions,showing the phenomenon of significant imbalance in regional development.(3)Mechanism analysis proves that rural social security fiscal expenditure and digitization level have played a significant role in promoting the coupling coordination level of rural primary health resource allocation and service utilization in China,while the fiscal decentralization and rural transportation infrastructure have an inhibitory effect.Based on the above empirical analysis,the following policy recommendations are put forward:(1)Optimize the allocation structure of primary health resources in rural areas.Achieve a shift from emphasizing material input to focusing on technological elements and the cultivation of talents,and from extensive to intensive management of primary health resources.(2)Promote the flow of health resources and service collaboration across regions at the rural grassroots level.Relying on national medical centers,national regional medical centers and other platforms,deepen health service cooperation among different regions.Strengthen policy learning and experience sharing among regions.(3)Improve the multiple mechanisms of action of coupling and coordination between the allocation of rural primary health resources and service utilization,including adjusting the fiscal investment mechanism for rural medical security;rationally dividing the financial and administrative power between the central and local governments in rural health services provision,expanding the autonomy of local governments in managing rural medical security affairs;achieving effective empowerment of digital technology for the rural health service system construction;and enhancing rural transportation infrastructure conditions.By conducting this study,it is expected to provide empirical evidence to promote the rational allocation of rural health resources,promote the accessibility,fairness and equalization of rural primary health services.
作者
黄妮
Huang Ni(Academy of Social Governance/School of Public Affairs,Zhejiang University,Hangzhou 310058,China)
出处
《浙江大学学报(人文社会科学版)》
北大核心
2025年第2期22-40,共19页
Journal of Zhejiang University:Humanities and Social Sciences
基金
国家社会科学基金青年项目(24CSH142)。
关键词
农村基层医疗资源配置
基层医疗服务利用
耦合协调
驱动机理
rural primary health resources allocation
utilization of primary health services
coupling coordination
driving mechanism
