背景:确保卫生人力资源的规模和层次结构是合理的,医疗服务是高效和公平的,是一项具有重要现实意义的工作。在此基础上,研究卫生人力资源对医疗服务水平的影响是一项新的艰巨挑战。本研究旨在探讨中国四大经济区域卫生人力资源的规模和等级结构如何影响医疗服务的公平性和效率。并确定优化策略。
方法:本研究利用2009年至2021年中国四大经济区域的省级面板数据。最初,它提供了卫生人力资源现状和医疗服务水平的统计描述。随后,它采用固定效应模型来分析卫生人力资源的规模和层次结构的影响,以及它们的互动效果,关于医疗服务的公平和效率,探讨了医疗服务公平与医疗服务效率的互动机制。此外,在运用熵权法对医疗服务水平进行综合评价后,探讨了卫生人力资源规模和等级结构对医疗服务水平影响的区域异质性和时间动态性。最后,该研究通过各种稳健性检查来检验研究结果的科学性和合理性,包括研究变量和模型的替代。
结果:研究发现,卫生人力资源规模对医疗服务公平性具有促进作用(β≤0.643,p≤0.01),但对医疗服务效率有抑制作用(β≥-0.079,p≤0.1);卫生人力资源的层级结构对医疗服务的公平性和效率均有正向影响(β公平≤0.160,p≤0.01;β效率≤0.341,p≤0.05);同时,结果表明,卫生人力资源的规模和层级结构的交互效应促进了医疗服务的公平性(β=0.067,p≤0.01),但制约了医疗服务效率(β≥-0.039,p≤0.01);我国西部和东北地区卫生人力资源对医疗服务水平的影响机制较中东部地区更为明显;《“健康中国2030”规划纲要》实施后,卫生人力资源在医疗服务水平中的作用得到加强;在稳健性测试中,在替换核心解释变量后,模型保持稳健,R2维持在0.869~0.972之间,动态GMM模型检验显示医疗服务水平存在显著的二阶滞后(β公平≤0.149,p≤0.01;β效率≤0.461,p≤0.01);渠道检验结果证明管理人员和其他技术人员是调节医务人员对医疗服务水平影响的关键途径。
结论:本研究深入分析了卫生人力资源对医疗服务水平的影响,卫生人力资源的规模和等级结构显著影响医疗服务的公平性和效率。此外,卫生人力资源对医疗服务水平的影响表现为区域异质性和时间特征。稳健性检验保证了研究结论的科学性和稳健性。这为优化卫生人力资源配置、提高医疗服务水平提供了有效参考。
BACKGROUND: Ensuring that the scale and hierarchical structure of health human resources are rational, and that medical services are efficient and fair, is an important task of practical significance. On this basis, examining the impact of health human resources on the level of medical services presents a new and formidable challenge. This study aims to delve into how the scale and hierarchical structure of health human resources in
China\'s four major economic regions affect the fairness and efficiency of medical services, and to identify optimization strategies.
METHODS: This study utilizes provincial panel data from
China\'s four major economic regions spanning the years 2009 to 2021. Initially, it provides a statistical description of the current state of health human resources and the level of medical services. Subsequently, it employs a fixed-effects model to analyze the impact of the scale and hierarchical structure of health human resources, as well as their interactive effects, on the fairness and efficiency of medical services, and discusses the interactive mechanisms between medical service fairness and medical service efficiency. Furthermore, after conducting a comprehensive evaluation of the level of medical services using the entropy weight method, it explores the regional heterogeneity and temporal dynamics in the influence of the scale and hierarchical structure of health human resources on the level of medical services. Finally, the study examines the scientific validity and rationality of the research findings through various robustness checks, including the substitution of research variables and models.
RESULTS: The study found that the scale of health human resources has a promoting effect on the equity of medical services (β ≤ 0.643, p ≤ 0.01), but exhibits an inhibitory effect on the efficiency of medical services (β ≥ -0.079, p ≤ 0.1); the hierarchical structure of health human resources shows a positive impact on both the equity and efficiency of medical services (βequity ≤ 0.160, p ≤ 0.01; βefficiency ≤ 0.341, p ≤ 0.05); at the same time, the results indicate that the interactive effect of the scale and hierarchical structure of health human resources promotes equity in medical services (β = 0.067, p ≤ 0.01), but restricts the efficiency of medical services (β ≥ -0.039, p ≤ 0.01); the mechanism by which health human resources affect the level of medical services in
China\'s western and northeastern regions is more pronounced than in the central and eastern regions; after the implementation of the \"Healthy
China 2030\" Planning Outline, the role of health human resources in the level of medical services has been strengthened; in the robustness tests, the model remains robust after replacing the core explanatory variables, with R2 maintained between 0.869 and 0.972, and the dynamic GMM model test shows a significant second-order lag in the level of medical services (βequity ≤ 0.149, p ≤ 0.01; βefficiency ≤ 0.461, p ≤ 0.01); the channel test results prove that managerial personnel and other technical personnel are key pathways in regulating the impact of medical staff on the level of medical services.
CONCLUSIONS: This study provides an in-depth analysis of the impact of health human resources on the level of medical services, revealing that both the scale and hierarchical structure of health human resources significantly affect the equity and efficiency of medical services. Furthermore, the influence of health human resources on the level of medical services exhibits regional heterogeneity and temporal characteristics. Robustness tests ensure the scientific validity and robustness of the research conclusions. This provides effective references for optimizing the allocation of health human resources and improving the level of medical services.