广西医学

目的基于数据包络分析（DEA）模型和双重差分（DID）模型分析分级诊疗制度对基层医疗卫生机构技术效率的影响。方法运用DEA模型评估2010—2022年全国31个省（自治区、直辖市）基层医疗卫生机构的技术效率（纯技术效率和规模效率），运用DID模型评估分级诊疗制度对基层医疗卫生机构技术效率的纯政策效应并进行稳健性检验。结果我国基层医疗卫生机构的技术效率偏低（均值0.773），存在显著的地区间及地区内部差异；纯技术效率和规模效率总体处于较高水平（均值分别为0.895、0.894），但地区间非均衡特征突出。分级诊疗制度、总人口数的回归系数为0.022、0.036（分别达到经济学实证研究10%、5%显著性水平），且结果具有稳健性。结论分级诊疗制度能够显著提升我国基层医疗卫生机构的技术效率，但地区间技术效率差异明显。结合地区特点采取针对性措施，有助于充分发挥分级诊疗制度改善基层医疗卫生机构技术效率的作用。

Objective To analyze the effect of the hierarchical medical system on technical efficiency of primary healthcare institutions based on data envelopment analysis (DEA) and difference⁃in⁃differences (DID) models. Methods The DEA model was used to evaluate the technical efficiency (including pure technical efficiency and scale efficiency) of primary healthcare institutions in 31 provinces (autonomous regions and municipalities directly under the central government) across China from 2010 to 2022. The DID model was used to evaluate the pure policy effect of the hierarchical medical system on the technical efficiency of primary healthcare institutions, and robustness tests were conducted. Results The technical efficiency of primary healthcare institutions in China was relatively low (mean value of 0.773), with significant inter⁃regional and intra⁃regional differences. Pure technical efficiency and scale efficiency were generally at a relatively high level (mean values of 0.895 and 0.894, respectively), but the characteristics of inter⁃regional imbalance were prominent. The regression coefficients of the hierarchical medical system and total population were 0.022 and 0.036 (reaching the 10% and 5% significance levels for empirical economic studies, respectively), and the results were robust. Conclusion The hierarchical medical system can significantly improve the technical efficiency of primary healthcare institutions in China, but there are obvious inter⁃regional differences in technical efficiency. Taking targeted measures according to regional characteristics can help give full play to the role of the hierarchical medical system in improving the technical efficiency of primary healthcare institutions.