Research On The Impact Of Transfer Payment On The Supply Of Medical Service Under The Background Of Graded Diagnosis And Treatment

The hierarchical healthcare system plays an important role in meeting the needs of the people's growing quality medical services.However,the hierarchical healthcare system in China faces the problem of insufficient and unbalanced supply of medical resources.The functional orientation of grading medical system does not match the status of medical service supply.As an important mechanism for the central government to motivate the local government to perform its duties,the transfer payment system has an important impact on the local government's medical service supply behavior.Based on this,this paper studies the impact of the transfer payment system on the local government medical service supply under the hierarchical healthcare system,and specifically analyzes the regional differences of medical services.Firstly,by building a theoretical model,this paper explores the roles of local government preferences and transfer payment on the provision of medical services supply.Then,by building the Topsis model of entropy weight,the overall imbalances of graded medical service supply are analyzed.And by the method of Kernel density estimation and ESDA-GIS,the spatialtemporal variation characteristics are examined.Next,by the Lorenz curve and Gini coefficient,the quantity and quality differences of medical service supply at all levels are measured.Finally,by constructing a fixed effect model and a panel threshold model,the impacts of transfer payment on medical service supply in the hierarchical healthcare system and treatment are analyzed.The study found that: the overall distributions of grading medical service in China present unbalanced.The high value areas of medical service supply in the hospital system and the urban primary healthcare institutions are mainly distributed in the middle and lower reaches of the Yangtze River and most of the area north of the Yellow River.The high value areas of medical service supply in the first of rural primary healthcare institutions are concentrated along the Yangtze River and in the coastal areas of East China.The high-value areas of medical service supply in the second of rural primary healthcare institutions are mainly concentrated in the north of the Huaihe River.The medical service supply in the hospital system,urban primary healthcare institutions and the second of rural primary healthcare institutions are highly global spatial auto-correlated,when the medical service supply in the second of rural primary healthcare institutions show a weak agglomeration status.There are obvious internal differences in the supply of graded medical services in China.The differences between the primary healthcare institutions are greater than the hospital system.The differences between the urban primary healthcare institutions are greater than the rural primary healthcare institutions.The differences between the first rural primary healthcare institutions are greater than the second rural primary healthcare institutions.The differences in quality of medical services are greater than the differences in quantity,and the degree of improvement in quality differences is less than the degree of improvement in quantity differences.There is a significant difference in quality of medical technicians among medical systems at all levels,and the differences in bed structure in hospital systems are significant.This paper identifies the incentive effects of transfer payment to medical service supply by fixed effect model.Furthermore,this paper identifies the effects are heterogeneous by panel threshold model.When the intensity of hierarchical healthcare system exceeds the threshold,the transfer payment has a positive incentive effect on the medical service supply,but when the intensity of hierarchical healthcare system is below the threshold,transfer payment significantly reduces the medical service supply.Based on above,this paper puts forward the policy recommendations,including actively improve the transfer payment system,optimize the performance evaluation mechanism of local officials,pay attention to the improvement of the quality of medical service supply,and improve the policy recommendations for the construction of the graded medical system.