| Background and Objective:In 2009,the Central Committee of the Communist Party of China and the State Council announced to the public opinions on deepening the reform of the medical and health system.In 2020,from the perspective of medical insurance,hospitals,drugs and other aspects,the system reform promoted by this opinion has achieved remarkable results,and the difficulties in seeking medical treatment,purchasing drugs,and reimbursement have been initially resolved.At the same time,the reform of the health care system has also withstood the test of the nationwide outbreak of COVID-19 in early 2020.While affirming the achievements of the reform,at the beginning of the outbreak of the epidemic,the medical resources have not been able to withstand strong pressure and low utilization efficiency.In order to ensure the sustained and healthy development of medical undertakings and safeguard the fundamental interests of the people,it is necessary to evaluate the efficiency and fairness of the utilization of medical resources in our country at the present stage.In recent years,with further regional cooperation,the enrichment of geographical data and the updating of spatial analysis methods and taking into account the spatial characteristics of the timeliness and proximity of medical resources acquisition,the impact of spatial geographical factors on the efficiency and fairness of medical resources utilization is worth exploring.Therefore,from the point of view of the agglomeration of medical resources,this study uses the method of spatial econometric analysis to focus on the efficiency and fairness of the utilization of medical resources.finally,the optimal spatial scale of government health expenditure under the condition of efficiency fairness and relative balance is obtained,which provides a theoretical reference for the government to formulate medical and health spatial intervention policies.Methods:(1)Agglomeration degree of medical resources was calculated from 2007 to 2018,using the medical income of each region,then the time and space trends were also described by using Stata 15.0 software.Geoda 1.2 software was used to make descriptive spatial statistics on the agglomeration degree of health resources,and the temporal and spatial trends of agglomeration degree in different regions of China were obtained.(2)From the perspective of dynamic change of agglomeration degree,Bayesian stochastic Frontier Model was used to estimate the influence and efficiency value of agglomeration degree on the efficiency of medical resources in China from 2007 to 2018 and then using Geoda 1.2 software to analyze the spatial autocorrelation of efficiency value.The spatial characteristics of fairness in the allocation of medical resources in China are measured from three angles and different geographical scales.The traditional calculation method of Gini coefficient is used to measure the fairness and spatial autocorrelation within each province from 2007 to 2017.Under the national geographic scale,the traditional Gini coefficient is horizontally decomposed into spatial adjacency component and spatial non-adjacent component,and the contribution of spatial geographical factors to Gini coefficient is estimated.On the national geographic scale,this paper studies the vertical decomposition of the traditional Gini coefficient,which concluded the contribution of the interaction between urbanization and aging to the Gini coefficient.(3)According to the values of efficiency and Gini coefficient,the Efficiency and Equality Balance Index is established.From the point of view of economic output brought by medical input,the influence of the Efficiency and Equality Balance Index and spatial geographical were considered to estimate the optimal scale of government medical input using Spatial Durbin panel model from 2008 to 2017.The long-term,short-term and spatial correlation effects of government health expenditure and the Efficiency and Equality Balance Index on government medical expenditure were analyzed.Results:(1)The results show that the agglomeration degree of medical resources in different regions of China does not change obviously with time,but there is a large gap among different regions:the agglomeration degree of medical resources in the economically developed eastern region is high,followed by the central region,and the western region is low.(2)From 2007 to 2018,the agglomeration of medical resources in China increased efficiency(P<0.05),and the average efficiency showed a small fluctuation.The increase of total health expenditure,the increase of licensed doctors per thousand people,the decrease of average length of stay and the decrease of beds per thousand people are conducive to the improvement of efficiency of medical resources.From the results of spatial autocorrelation analysis,we can see that the low value of efficiency value is concentrated in Qinghai,Sichuan and its surrounding areas in 2007(P<0.05),Xinjiang,Heilongjiang,Liaoning,Jilin and their surrounding areas in 2011(P<0.05);high low value clustering only exists in Beijing and its surrounding areas in 2018(P<0.05).The equity of health resources within China's provinces decreased slightly from 2007 to 2017.The fairness of the number of beds per thousand population(G=0.31)is slightly better than that of doctors per thousand population(G=0.33).There is a significant aggregation of the unfair number of doctors per thousand people in Tibet and Sichuan;there is a significant accumulation of the number of doctors per thousand people in Shandong,Anhui and Zhejiang;the unfair distribution of doctors per thousand people in Hubei Province is more serious than that in the surrounding provinces.Different from the unfair situation within the provinces,the provincial data were used to analyze and found that the equity of medical resources allocation in China increased as a whole.According to the level analysis of spatial Gini coefficient,the contribution of spatial geographical factors to the Gini coefficient of medical resources is about 15%.The vertical decomposition of spatial Gini coefficient shows that the contribution of the interaction between urbanization and aging to Gini coefficient is 16.46%-20.67%.(3)After constructing the Efficiency Equity Balance Index(EEBI),it is found that the balance between fairness and efficiency exists not only in the areas with strong economic development,but also in the areas with weak economic development.In the central region of China,the distribution of EEBI index is more concentrated,while in the western and eastern regions of China,the distribution of EEBI index is more scattered,with more trailing values in the western region and more head values in the eastern region.After confirming the two-way causal relationship between government medical expenditure and economic growth by using Granger causality inference,we first use the traditional Barro panel model to analyze that the optimal scale of government health expenditure in China is 4.0%of GDP(P=0.024).Then,with the EEBI and spatial geography factors,using dynamic spatial Durbin model for analysis,it is found that the optimal scale of Chinese government medical and health expenditure is 5.09%(P<0.01).The growth of regional economy is driven not only by the growth of local government health expenditure and other expenditure,but also by the positive spillover of government health expenditure and other expenditure in neighboring areas.and the long-term effects of these two effects are greater than the short-term.The efficiency and EEBI index have no direct impact on the growth of GDP in this region but has a positive impact on EEBI index in other neighboring areas,showing the "leadership effect" in the agglomeration center and the "catch-up effect" in other areas.Moreover,the reasonable,effective and fair allocation of medical resources in other areas has a positive contribution to the GDP of this region and has a greater long-term impact.Conclusions:There is a certain degree of agglomeration in the distribution of medical resources in China,which would increase the utilization efficiency of medical resources.In recent ten years,the spatial agglomeration of medical bed resources tends to weaken,while that of medical practitioners tends to be polarized.It is suggested that more attention should be paid to the deepening of inequality brought about by the process of aging and urbanization.In the current state of efficiency and equity balance,China is still in the stage that the increase of government health expenditure can promote health and economic development.It is suggested that the total scale of government health expenditure should be further increased,and be matched with the local social development level and people's health service demand according to local conditions. |
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