Objective To explore the trend of total factor productivity of township health services in China from 2003 to 2014.Methods Based on the panel data from 10 volumes ofChina's Health Statistical Yearbook (2004—2013) and 2 volumes ofChina's Health and Family Planning Statistical Yearbook (2014—2015), the township hospitals in 29 provinces (or autonomous regions or municipalities directly under the central government), excluding Beijing and Shanghai, were selected as the subjects. DEA-Malmquist index was used to analyze the changes in total factor productivity of township health services in China. The input indicators include the number of township hospitals, number of township health professionals and number of beds in township hospitals, and the output indicators include the number of visits, bed occupancy rate, and average length of stay in the hospital.Results Compared with 2003, the number of township hospitals per 1000 rural population, number of health professionals per 1000 rural population, number of beds per 1000 rural population, number of visits, bed occupancy rate and average length of stay in township hospitals in China in 2014 increased by -0.01, 0.19, 0.58, 337319263, 24.26 percentage points, 2.09 days, respectively, with an average annual growth rate of -2.01％, 1.57％, 5.29％, 3.68％, 4.77％, 3.73％, respectively during 2003—2014. During 2003—2014, the average technical efficiency, pure technical efficiency and scale efficiency of township health services in China was 0.767-0.892, 0.860-0.919, and 0.876-0.968, respectively, the mean value was 0.830, 0.887 and 0.930 for each of them. During 2003—2014, the technical efficiency change index of township health services declined by 0.5％, the technical change index increased by 2.8％, the pure technical efficiency change index increased by 0.3％, the scale efficiency change index decreased by 0.8％, and the total factor productivity change index increased by 2.3％. During the same period, in eastern, central and western regions of China, the mean value of technical efficiency change index was 0.996, 1.006 and 0.987, respectively, the mean value of technical change index was 1.048, 1.023 and 1.017, respectively, the mean value of pure technical efficiency change index was 1.003, 1.008 and 1.000, respectively, the mean value of scale efficiency change index was 0.993, 0.999 and 0.987, respectively and the mean value of total factor productivity change was 1.044, 1.029 and 1.004, respectively.Conclusion During 2003—2014, the national total factor productivity showed a rising trend generally, but significant differences were found between the three regions. Technological progress is the main contributor while scale efficiency is the main constraint for the improvement of the total factor productivity of township health services in China. In view of this, properly regional planning and taking targeted measures in response to the characteristics of changes in technical efficiency and technical progress in local regions become the two feasible approaches to improve the efficiency of township health services in China.%目的 探讨2003—2014年我国乡镇卫生服务全要素生产率变化趋势.方法 基于2004—2013年《中国卫生统计年鉴》以及2014—2015年《中国卫生和计划生育统计年鉴》数据,选取我国29个省/自治区/直辖市(除外北京、上海)的乡镇卫生院为研究对象.采用数据包络分析(DEA)-Malmquist指数法对我国乡镇卫生服务全要素生产率变化情况进行分析.其中,投入指标包括乡镇卫生院数、乡镇卫生技术人员数、乡镇卫生院床位数,产出指标包括诊疗人次、病床使用率、平均住院日.结果 2003—2014年,我国每千农业人口乡镇卫生院机构数增加了-0.01个,年均增长率为-2.01％;每千农业人口卫生技术人员数增加了0.19名,年均增长率为1.57％;每千农业人口乡镇卫生院床位数增加了0.58张,年均增长率为5.29％;乡镇卫生院诊疗人次增加了337319263人次,年均增长率为3.68％;病床使用率上升了24.26个百分点,年均增长率为4.77％;平均住院日增加了2.09 d,年均增长率为3.73％.2003—2014年我国乡镇卫生服务平均技术效率、纯技术效率、规模效率分别为0.767～0.892、0.860～0.919、0.876～0.968,均值分别为0.830、0.887、0.930.2003—2014年,我国乡镇卫生服务技术效率变化指数下降了0.5％,技术变化指数提高了2.8％,纯技术效率变化指数提高了0.3％,规模效率变化指数下降了0.8％,全要素生产率变化指数提高了2.3％.2003—2014年,我国东部、中部、西部地区技术效率变化指数均值分别为0.996、1.006、0.987;技术变化指数均值分别为1.048、1.023、1.017;纯技术效率变化指数均值分别为1.003、1.008、1.000;规模效率变化指数均值分别为0.993、0.999、0.987;全要素生产率变化指数均值分别为1.044、1.029、1.004.结论 2003—2014年,我国乡镇卫生服务全要素生产率呈上升趋势,但各区域间存在明显差异.技术进步是乡镇卫生服务全要素生产率提高的主要原因,而规模效率是制约全要素生产率增长的主要因素.要提高我国乡镇卫生服务效率,必须做好区域统筹规划工作,针对各区域技术效率与技术进步的变化特征采取不同的措施.
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