目的 评价2013—2015年我国社区卫生服务中心卫生服务效率,为优化卫生资源配置提供政策建议.方法 基于2014—2016年《中国卫生和计划生育统计年鉴》,选取我国30个省/自治区/直辖市(除外西藏)的社区卫生服务中心为研究对象.采用数据包络分析(DEA)-Malmquist指数法对我国整体及不同地区社区卫生服务中心的卫生服务效率进行分析.其中,投入指标包括社区卫生服务中心数、卫生人员数、床位数,产出指标包括诊疗人次、入院人数、病床使用率、平均住院日.结果 2015年我国30个地区社区卫生服务中心卫生服务的综合技术效率、纯技术效率、规模效率平均数分别为0.715、0.705、0.972.其中8个地区(26.7%)综合技术效率为1.000,达到技术有效,包括广东、贵州、海南、宁夏、青海、上海、浙江、重庆.其余22个地区平均过剩131个社区卫生服务中心、5573名卫生人员、2086张床位.2013—2015年,我国社区卫生服务中心服务技术效率变化指数平均为0.990,下降了1.0%;技术变化指数平均为1.034,提高了3.4%;纯技术效率变化指数平均为1.002,提高了0.2%;规模效率变化指数平均为0.988,下降了1.2%;全要素生产率平均为1.024,提高了2.4%.结论 2013—2015年我国社区卫生服务中心的卫生服务效率总体呈上升趋势,但各区域间存在明显差异.非DEA有效地区的社区卫生资源存在不足与浪费共存的问题,应积极采取措施优化资源配置,加强社区卫生服务中心管理水平,提高卫生服务效率.%Objective We explored the efficiency of community health service centers (CHSCs) in China from 2013 to 2015, providing policy suggestions for optimizing the allocation of health resources. Methods From 3 volumes of China's Health and Family Planning Statistical Yearbook (2014—2016), we collected the data about the efficiency of CHSCs in 30 provinces (autonomous regions/municipalities) in mainland China (except Tibet) from 2013 to 2015. Data envelopment analysis (DEA) and Malmquist index analysis were performed to investigate the dynamic changes in the efficiency of these CHSCs during this period at the national level as well as the provincial level. The input indicators include the numbers of CHSCs, primary care providers and beds. The output indicators consist of visits, number of inpatients, occupancy rate of beds and average length of stay. Results In 2015, the average national comprehensive technical efficiency, average national pure technical efficiency and average national scale efficiency of CHSCs were 0.715, 0.705 and 0.972 respectively; Eight regions (Guangdong, Guizhou, Hainan, Ningxia, Qinghai, Shanghai, Zhejiang and Chongqing, accounting for 26.7%) owned effective comprehensive technical efficiency with a value of 1.000, the other 22 regions had an average surplus 131 CHSCs, 5 573 primary care providers and 2 086 beds. Compared with 2013, in 2015, the average national technical efficiency change index of CHSCs was 0.990, decreased by 1.0%, average national technical change index of CHSCs was 1.034, increased by 3.4%, average national pure technical efficiency change index of CHSCs was 1.002, increased by 0.2%, average national scale efficiency change index of CHSCs was 0.988, decreased by 1.2%, the total factor productivity of CHSCs was 1.024, increased by 2.4%. Conclusion From 2013 to 2015, the efficiency of CHSCs generally presented a rising trend at the national level, but it also displayed obvious provincial-specific differences. In the areas owning inefficient CHSCs identified by DEA analysis, there was a problem of coexistence of insufficiency and waste of community health resources. In view of this, targeted measures should be taken to optimize the allocation of community health resources, and the management level of CHSCs should be strengthened in order to improve the efficiency of these institutions.
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