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Article(id=1311350338184114703, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350193946194882, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202512240, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1765641600000, receivedDateStr=2025-12-14, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579884334, onlineDateStr=2026-09-28, pubDate=1786291200000, pubDateStr=2026-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579884334, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579884334, creator=13701087609, updateTime=1790579884334, updator=13701087609, issue=Issue{id=1311350193946194882, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='15', pageStart='2689', pageEnd='2880', issueExtLink='null', onlineDate='null', pubDate='1786291200000', pubDateStr='2026-08-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1790579849945, creator='13701087609', updateTime=1790588319569, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311385718195315029, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350193946194882, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311385718195315030, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350193946194882, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2813, endPage=2819, ext={EN=ArticleExt(id=1311350338414801424, articleId=1311350338184114703, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Coupling coordination level and evolution of constraining factors in health expenditure, medical resources, and medical services in China since the new healthcare reform, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the coupling coordination level and limiting factors of the health expenditure input system, the medical resource allocation system, and the health service efficiency system and to provide references for promoting the high-quality development of health services in China since the new healthcare reform.

Methods

The coupling coordination model and obstacle degree model were used to analyze the coupling coordination degree and the evolution of obstacle factors among the three systems in 31 provinces of China from 2010 to 2023.

Results

The average coupling coordination degree increased from 0.06 in 2010 to 0.52 in 2023, showing a slow upward trend but not reaching a moderate coordination level (<0.6). Qinghai only increased from 0.02 to 0.31. The average obstacle degree of the key obstacle factors rose from 0.10 to 0.32. The key obstacle factors gradually shifted from multiple input-related indicators, such as limited government investment and inadequate development of the healthcare workforce, to two efficiency-related indicators: relatively high average outpatient and inpatient costs.

Conclusion

The coupling coordination level of the three systems needs further improvement. The key obstacle factors have evolved from multiple input-based indicators to two efficiency-based ones. It is necessary to further enhance the coordinated development of those systems by diversifying strategies, such as perfecting adaptive policies to address shortcomings in coordinated development, optimizing the structure of medical services to reduce medical costs, and improving health expenditure input and utilization mechanisms through market mechanisms.

, authors=Ji-hong LI1, Fang ZHANG1, Zhao-cheng YANG1, 2, Fu-sheng XIE3, authorsList=Ji-hong LI, Fang ZHANG, Zhao-cheng YANG, Fu-sheng XIE, authorCompany=null, correspAuthors=Zhao-cheng YANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1311350339454988825, articleId=1311350338184114703, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=新医改以来我国卫生经费、医疗资源、医疗服务耦合协调水平与障碍因子演变研究, columnId=1228016568014139551, journalTitle=现代预防医学, columnName=卫生政策与管理, runingTitle=null, highlight=null, articleAbstract=
目的

探索新医改以来我国卫生经费投入系统、医疗资源配置系统和医疗服务效率系统耦合协调水平与制约因素，为推进我国医疗服务高质量发展提供参考。

方法

采用耦合协调模型和障碍度模型分析2010—2023年我国31个省份三系统耦合协调度和障碍因子演变。

结果

耦合协调度均值由2010年的0.06提升到2023年的0.52，各省份呈现缓慢上升趋势但未达到中级协调水平（<0.6），青海仅从0.02增至0.31；关键障碍因子障碍度均值从0.10增至0.32，从卫生经费投入系统和医疗资源配置系统的政府投入有限、人力资源队伍建设薄弱等多个指标逐渐演变为医疗服务效率系统的门诊与住院次均费用偏高等两个指标。

结论

我国三系统耦合协调水平有待进一步提高，关键障碍因子由多个投入型指标演变为2个效率型指标。应进一步从针对协调发展短板完善适配政策、优化医疗服务结构降低医疗费用、利用市场机制完善经费投入与利用机制等多方面提高三者协调发展水平。

, authors=李继宏1, 张方1, 杨兆城1, 2, 谢福生3, authorsList=李继宏, 张方, 杨兆城, 谢福生, authorCompany=null, correspAuthors=杨兆城, authorNote=

李继宏（1970—），博士，副教授，研究方向：卫生政策与管理

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杨兆城，E-mail:
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李继宏（1970—），博士，副教授，研究方向：卫生政策与管理

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Journal of Peking University(Health Sciences), 2024, 56(3): 462-470.(In Chinese), articleTitle=Main characteristics and historical evolution of China's health financing transition, refAbstract=null)], funds=[Fund(id=1311350346186846804, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, awardId=2023M740531, language=CN, fundingSource=中国博士后科学基金面上资助项目(2023M740531), fundOrder=null, country=null), Fund(id=1311350346262344277, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, awardId=23FYJ029, language=CN, fundingSource=广西哲学社会科学研究课题(23FYJ029), fundOrder=null, country=null), Fund(id=1311350346333647447, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, awardId=null, language=CN, fundingSource=广西八桂学者“社会医学与卫生事业管理”岗位基金资助, fundOrder=null, country=null)], companyList=[AuthorCompany(id=1311350339698258458, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, xref=1., ext=[AuthorCompanyExt(id=1311350339715035675, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, companyId=1311350339698258458, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Humanities and Management, Guilin Medical University, Guilin, Guangxi 541199, China), AuthorCompanyExt(id=1311350339723424284, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, companyId=1311350339698258458, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1. 桂林医科大学人文与管理学院，广西 桂林 541199)]), AuthorCompany(id=1311350339798921757, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, xref=2., ext=[AuthorCompanyExt(id=1311350339811504670, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, companyId=1311350339798921757, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2. 桂林医科大学财务处，广西 桂林 541199)]), AuthorCompany(id=1311350339895390751, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, xref=3., ext=[AuthorCompanyExt(id=1311350339907973664, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, companyId=1311350339895390751, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.桂林医科大学第二附属医院)])], figs=[ArticleFig(id=1311350343523463747, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, language=EN, label=Figure 1, caption=Evolution trend of coupling coordination degree from 2010 to 2023, figureFileSmall=au+ryBcUDZHIuLBr6iHLYA==, figureFileBig=JJWMzebyaSspegUX2nkG1Q==, tableContent=null), ArticleFig(id=1311350343586378308, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, language=CN, label=图1, caption=2010—2023年耦合协调度演变趋势, figureFileSmall=au+ryBcUDZHIuLBr6iHLYA==, figureFileBig=JJWMzebyaSspegUX2nkG1Q==, tableContent=null), ArticleFig(id=1311350343846425158, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, language=EN, label=Figure 2, caption=Evolution trend of three-system obstacle degree from 2010 to 2023, figureFileSmall=pGwqpTV2dhGcDcM68F5tlw==, figureFileBig=UenLAwN99l23l4EPm0a26w==, tableContent=null), ArticleFig(id=1311350343934505543, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, language=CN, label=图2, caption= 2010—2023年三系统障碍度演变趋势

注：列标题由系统代码+年份组成，如A2010为2010年卫生经费投入系统，代码见表1。

, figureFileSmall=pGwqpTV2dhGcDcM68F5tlw==, figureFileBig=UenLAwN99l23l4EPm0a26w==, tableContent=null), ArticleFig(id=1311350344014197321, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, language=EN, label=Table 1, caption=

The evaluation index system of coupling coordination level

, figureFileSmall=null, figureFileBig=null, tableContent=
一级指标代码二级指标代码属性权重均值
卫生经费投入A政府卫生支出占卫生总费用比重（%）A1正向0.051 8
个人卫生支出占卫生总费用比重（%）A2负向0.070 3
卫生总费用占GDP比重（%）A3正向0.074 4
人均卫生费用（元）A4正向0.080 4
床均财政补助（元）A5正向0.068 8
医疗资源配置B三级医院占医院比重（%）B1正向0.062 4
每千人医疗机构床位数（张）B2正向0.061 9
每千人卫生技术人员数B3正向0.075 2
每千人执业（助理）医师数B4正向0.090 9
每千人注册护士数B5正向0.072 5
医疗服务效率C每千人诊疗人次（人次）C1正向0.042 8
门诊次均医疗费（元）C2负向0.062 9
住院次均医疗费（元）C3负向0.084 2
平均住院日（天）C4负向0.043 9
床均医疗收入（元）C5正向0.057 7
), ArticleFig(id=1311350344102277706, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, language=CN, label=表1, caption=

耦合协调水平的评价指标体系

, figureFileSmall=null, figureFileBig=null, tableContent=
一级指标代码二级指标代码属性权重均值
卫生经费投入A政府卫生支出占卫生总费用比重（%）A1正向0.051 8
个人卫生支出占卫生总费用比重（%）A2负向0.070 3
卫生总费用占GDP比重（%）A3正向0.074 4
人均卫生费用（元）A4正向0.080 4
床均财政补助（元）A5正向0.068 8
医疗资源配置B三级医院占医院比重（%）B1正向0.062 4
每千人医疗机构床位数（张）B2正向0.061 9
每千人卫生技术人员数B3正向0.075 2
每千人执业（助理）医师数B4正向0.090 9
每千人注册护士数B5正向0.072 5
医疗服务效率C每千人诊疗人次（人次）C1正向0.042 8
门诊次均医疗费（元）C2负向0.062 9
住院次均医疗费（元）C3负向0.084 2
平均住院日（天）C4负向0.043 9
床均医疗收入（元）C5正向0.057 7
), ArticleFig(id=1311350344169386572, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, language=EN, label=Table 2, caption=

Classification of coupling coordination degree

, figureFileSmall=null, figureFileBig=null, tableContent=
D值范围[0，0.2）[0.2，0.4）[0.4，0.6）[0.6，0.8）[0.8，1]
等级划分严重失调轻度失调初级协调中级协调高级协调
), ArticleFig(id=1311350344236495437, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, language=CN, label=表2, caption=

耦合协调度等级划分

, figureFileSmall=null, figureFileBig=null, tableContent=
D值范围[0，0.2）[0.2，0.4）[0.4，0.6）[0.6，0.8）[0.8，1]
等级划分严重失调轻度失调初级协调中级协调高级协调
), ArticleFig(id=1311350344303604302, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, language=EN, label=Table 3, caption=

Major obstacle factors ranked in the top three from 2010 to 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
区域2010年2011年2012年2013年2014年2015年2016年2017年2018年2019年2020年2021年2022年2023年
全国B4(0.12)B4(0.12)B4(0.12)B4(0.12)B4(0.12)B4(0.13)B4(0.13)B4(0.12)B4(0.10)C3(0.13)C3(0.19)C3(0.20)C3(0.25)C3(0.46)
A4(0.10)A4(0.10)A4(0.10)A4(0.10)A4(0.10)A4(0.11)A4(0.10)A4(0.09)C3(0.10)A1(0.11)C2(0.13)A1(0.15)C2(0.17)C2(0.40)
B3(0.10)B3(0.10)B3(0.10)A3(0.10)A3(0.10)B3(0.10)B3(0.10)B1(0.09)A1(0.09)B4(0.09)B4(0.09)C2(0.13)A1(0.13)A1(0.10)
东部B4(0.12)B4(0.13)B4(0.14)B4(0.12)B4(0.14)B4(0.14)B4(0.14)B4(0.12)B4(0.12)C3(0.15)C3(0.20)C3(0.22)C3(0.33)C3(0.37)
B3(0.11)B3(0.11)B3(0.12)B2(0.10)B3(0.12)B3(0.12)B3(0.11)B3(0.11)C3(0.11)A1(0.10)C2(0.13)A1(0.16)C2(0.22)C2(0.32)
B5(0.10)B5(0.10)B5(0.10)B3(0.10)B5(0.10)B5(0.10)B5(0.10)C3(0.09)A1(0.10)B4(0.10)C1(0.10)C2(0.14)C1(0.10)A1(0.26)
中部B4(0.11)B4(0.12)B4(0.11)B4(0.12)B4(0.11)B4(0.12)B4(0.12)B4(0.11)B1(0.11)A1(0.15)C3(0.18)A1(0.19)C3(0.21)A1(0.38)
B3(0.10)B3(0.10)A2(0.11)B3(0.10)A3(0.10)B3(0.10)B3(0.10)B1(0.10)A1(0.11)B1(0.11)C2(0.14)C3(0.17)A1(0.20)C2(0.27)
A2(0.09)A3(0.10)B3(0.09)A2(0.10)B3(0.09)B5(0.09)B1(0.10)B3(0.09)B4(0.10)B4(0.10)B1(0.14)C2(0.12)C2(0.18)C3(0.25)
西部B1(0.14)B1(0.15)B1(0.15)B1(0.15)B1(0.16)B1(0.17)B1(0.16)B1(0.17)A1(0.17)A1(0.19)C3(0.25)C3(0.25)C3(0.30)C3(0.38)
B4(0.11)B4(0.12)B4(0.11)B4(0.12)B4(0.11)B4(0.11)B4(0.12)A1(0.11)B1(0.15)C3(0.16)B1(0.13)A1(0.21)A1(0.23)A1(0.33)
B5(0.10)B5(0.10)B5(0.10)B5(0.10)B5(0.09)B5(0.09)C3(0.10)C3(0.11)C3(0.13)B1(0.14)C2(0.11)C2(0.11)C2(0.14)C2(0.23)
), ArticleFig(id=1311350344366518864, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, language=CN, label=表3, caption=

2010—2023年障碍度排名前三的主要障碍因子

, figureFileSmall=null, figureFileBig=null, tableContent=
区域2010年2011年2012年2013年2014年2015年2016年2017年2018年2019年2020年2021年2022年2023年
全国B4(0.12)B4(0.12)B4(0.12)B4(0.12)B4(0.12)B4(0.13)B4(0.13)B4(0.12)B4(0.10)C3(0.13)C3(0.19)C3(0.20)C3(0.25)C3(0.46)
A4(0.10)A4(0.10)A4(0.10)A4(0.10)A4(0.10)A4(0.11)A4(0.10)A4(0.09)C3(0.10)A1(0.11)C2(0.13)A1(0.15)C2(0.17)C2(0.40)
B3(0.10)B3(0.10)B3(0.10)A3(0.10)A3(0.10)B3(0.10)B3(0.10)B1(0.09)A1(0.09)B4(0.09)B4(0.09)C2(0.13)A1(0.13)A1(0.10)
东部B4(0.12)B4(0.13)B4(0.14)B4(0.12)B4(0.14)B4(0.14)B4(0.14)B4(0.12)B4(0.12)C3(0.15)C3(0.20)C3(0.22)C3(0.33)C3(0.37)
B3(0.11)B3(0.11)B3(0.12)B2(0.10)B3(0.12)B3(0.12)B3(0.11)B3(0.11)C3(0.11)A1(0.10)C2(0.13)A1(0.16)C2(0.22)C2(0.32)
B5(0.10)B5(0.10)B5(0.10)B3(0.10)B5(0.10)B5(0.10)B5(0.10)C3(0.09)A1(0.10)B4(0.10)C1(0.10)C2(0.14)C1(0.10)A1(0.26)
中部B4(0.11)B4(0.12)B4(0.11)B4(0.12)B4(0.11)B4(0.12)B4(0.12)B4(0.11)B1(0.11)A1(0.15)C3(0.18)A1(0.19)C3(0.21)A1(0.38)
B3(0.10)B3(0.10)A2(0.11)B3(0.10)A3(0.10)B3(0.10)B3(0.10)B1(0.10)A1(0.11)B1(0.11)C2(0.14)C3(0.17)A1(0.20)C2(0.27)
A2(0.09)A3(0.10)B3(0.09)A2(0.10)B3(0.09)B5(0.09)B1(0.10)B3(0.09)B4(0.10)B4(0.10)B1(0.14)C2(0.12)C2(0.18)C3(0.25)
西部B1(0.14)B1(0.15)B1(0.15)B1(0.15)B1(0.16)B1(0.17)B1(0.16)B1(0.17)A1(0.17)A1(0.19)C3(0.25)C3(0.25)C3(0.30)C3(0.38)
B4(0.11)B4(0.12)B4(0.11)B4(0.12)B4(0.11)B4(0.11)B4(0.12)A1(0.11)B1(0.15)C3(0.16)B1(0.13)A1(0.21)A1(0.23)A1(0.33)
B5(0.10)B5(0.10)B5(0.10)B5(0.10)B5(0.09)B5(0.09)C3(0.10)C3(0.11)C3(0.13)B1(0.14)C2(0.11)C2(0.11)C2(0.14)C2(0.23)
), ArticleFig(id=1311350344442016337, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, language=EN, label=Table 4, caption=

High-frequency obstacle factors with a frequency of ≥3 from 2010 to 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
区域2010年2011年2012年2013年2014年2015年2016年2017年2018年2019年2020年2021年2022年2023年
全国B4(21)B4(22)B4(22)B4(20)B4(23)B4(24)B4(20)B4(18)A1(17)C3(18)C3(29)C3(30)C3(31)C3(29)
B5(13)B5(13)B5(14)B3(12)B3(12)B3(13)B1(14)B1(14)B1(17)A1(15)C2(23)C2(24)C2(26)C2(27)
B3(12)B1(12)B3(13)B5(12)B1(11)B5(12)B3(10)A1(11)B4(15)B1(15)B1(11)A1(21)A1(18)A1(26)
B1(11)B3(11)B1(11)B1(11)B5(11)B1(11)B5(10)B3(11)C3(14)B4(12)B4(9)B1(5)B1(5)A5(3)
A5(9)A3(8)A3(7)A4(10)A3(8)A5(9)A1(7)C3(11)A5(7)C2(11)A1(6)C1(3)C1(4)
A3(8)A4(8)A4(7)A3(7)A4(8)A4(7)A5(7)A5(7)B3(6)A5(6)C1(4)
A4(8)A2(5)A5(6)A5(6)A5(7)A3(6)C3(6)B5(6)A3(3)B3(6)C4(4)
B2(3)A5(5)B2(4)B2(5)A1(6)A1(4)A3(5)A3(4)A4(3)
A1(4)B2(3)B2(3)A4(5)A4(4)B5(3)
A2(3)B2(3)B2(3)
东部A4(5)A4(5)B4(6)A4(7)B4(6)B4(8)B4(6)A1(6)A1(7)C3(7)C2(10)C2(10)C3(11)C2(10)
A5(5)B4(5)A4(4)A5(4)A4(4)A5(4)A5(4)B4(5)C3(6)A1(6)C3(10)C3(10)C2(10)C3(10)
B4(5)A3(4)A5(4)A3(3)A5(4)B3(4)A4(3)A4(4)B1(5)C2(5)B1(3)A1(9)A1(6)A1(9)
A3(4)A2(3)B3(4)B2(3)B3(4)B5(4)B1(3)C3(4)A4(3)B1(4)B1(3)
B3(3)A5(3)B5(4)B3(3)A1(3)A1(3)B3(3)A5(3)B4(3)B4(3)
B5(3)B3(3)B4(3)A3(3)A4(3)C3(3)B1(3)
B5(3)B5(3)B5(3)
中部B4(7)B4(7)B4(7)B3(7)B3(6)B4(7)B4(6)B4(6)B4(6)B4(5)C3(8)C3(8)C3(8)A1(8)
B3(6)B3(6)B3(6)B4(7)B4(7)B3(6)B3(5)B3(5)B1(4)B1(4)C2(6)C2(5)C2(7)C2(7)
B5(3)B5(3)B5(3)B5(3)B5(3)B5(3)B5(3)B1(3)B3(4)B3(4)B1(4)A1(4)A1(4)C3(7)
C3(4)B4(4)
西部B4(9)B4(10)B4(9)B4(10)B4(10)B4(9)B1(9)B1(8)A1(8)A1(7)C3(11)C3(12)C3(12)C3(12)
B1(8)B1(9)B1(8)B1(8)B1(9)B1(8)B4(8)B4(7)B1(8)B1(7)C2(7)C2(9)C2(9)C2(10)
B5(7)B5(7)B5(7)B5(6)B5(5)B5(5)B5(5)C3(5)B4(6)C3(7)A1(4)A1(8)A1(8)A1(9)
A5(3)A3(3)A3(3)A3(3)A5(4)A1(3)A1(4)C3(6)B4(4)B1(4)C1(3)
B3(3)B3(3)A3(3)A3(3)B3(4)C2(4)B4(4)
B3(3)C3(3)A5(3)
), ArticleFig(id=1311350346065211986, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350338184114703, language=CN, label=表4, caption=

2010—2023年频次≥3的高频次障碍因子

, figureFileSmall=null, figureFileBig=null, tableContent=
区域2010年2011年2012年2013年2014年2015年2016年2017年2018年2019年2020年2021年2022年2023年
全国B4(21)B4(22)B4(22)B4(20)B4(23)B4(24)B4(20)B4(18)A1(17)C3(18)C3(29)C3(30)C3(31)C3(29)
B5(13)B5(13)B5(14)B3(12)B3(12)B3(13)B1(14)B1(14)B1(17)A1(15)C2(23)C2(24)C2(26)C2(27)
B3(12)B1(12)B3(13)B5(12)B1(11)B5(12)B3(10)A1(11)B4(15)B1(15)B1(11)A1(21)A1(18)A1(26)
B1(11)B3(11)B1(11)B1(11)B5(11)B1(11)B5(10)B3(11)C3(14)B4(12)B4(9)B1(5)B1(5)A5(3)
A5(9)A3(8)A3(7)A4(10)A3(8)A5(9)A1(7)C3(11)A5(7)C2(11)A1(6)C1(3)C1(4)
A3(8)A4(8)A4(7)A3(7)A4(8)A4(7)A5(7)A5(7)B3(6)A5(6)C1(4)
A4(8)A2(5)A5(6)A5(6)A5(7)A3(6)C3(6)B5(6)A3(3)B3(6)C4(4)
B2(3)A5(5)B2(4)B2(5)A1(6)A1(4)A3(5)A3(4)A4(3)
A1(4)B2(3)B2(3)A4(5)A4(4)B5(3)
A2(3)B2(3)B2(3)
东部A4(5)A4(5)B4(6)A4(7)B4(6)B4(8)B4(6)A1(6)A1(7)C3(7)C2(10)C2(10)C3(11)C2(10)
A5(5)B4(5)A4(4)A5(4)A4(4)A5(4)A5(4)B4(5)C3(6)A1(6)C3(10)C3(10)C2(10)C3(10)
B4(5)A3(4)A5(4)A3(3)A5(4)B3(4)A4(3)A4(4)B1(5)C2(5)B1(3)A1(9)A1(6)A1(9)
A3(4)A2(3)B3(4)B2(3)B3(4)B5(4)B1(3)C3(4)A4(3)B1(4)B1(3)
B3(3)A5(3)B5(4)B3(3)A1(3)A1(3)B3(3)A5(3)B4(3)B4(3)
B5(3)B3(3)B4(3)A3(3)A4(3)C3(3)B1(3)
B5(3)B5(3)B5(3)
中部B4(7)B4(7)B4(7)B3(7)B3(6)B4(7)B4(6)B4(6)B4(6)B4(5)C3(8)C3(8)C3(8)A1(8)
B3(6)B3(6)B3(6)B4(7)B4(7)B3(6)B3(5)B3(5)B1(4)B1(4)C2(6)C2(5)C2(7)C2(7)
B5(3)B5(3)B5(3)B5(3)B5(3)B5(3)B5(3)B1(3)B3(4)B3(4)B1(4)A1(4)A1(4)C3(7)
C3(4)B4(4)
西部B4(9)B4(10)B4(9)B4(10)B4(10)B4(9)B1(9)B1(8)A1(8)A1(7)C3(11)C3(12)C3(12)C3(12)
B1(8)B1(9)B1(8)B1(8)B1(9)B1(8)B4(8)B4(7)B1(8)B1(7)C2(7)C2(9)C2(9)C2(10)
B5(7)B5(7)B5(7)B5(6)B5(5)B5(5)B5(5)C3(5)B4(6)C3(7)A1(4)A1(8)A1(8)A1(9)
A5(3)A3(3)A3(3)A3(3)A5(4)A1(3)A1(4)C3(6)B4(4)B1(4)C1(3)
B3(3)B3(3)A3(3)A3(3)B3(4)C2(4)B4(4)
B3(3)C3(3)A5(3)
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新医改以来我国卫生经费、医疗资源、医疗服务耦合协调水平与障碍因子演变研究
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李继宏 1 , 张方 1 , 杨兆城 1, 2 , 谢福生 3
现代预防医学 | 卫生政策与管理 2026,53(15): 2813-2819
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现代预防医学 |卫生政策与管理 2026 , 53 (15) : 2813 -2819
新医改以来我国卫生经费、医疗资源、医疗服务耦合协调水平与障碍因子演变研究
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李继宏（1970—），博士，副教授，研究方向：卫生政策与管理

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李继宏1, 张方1, 杨兆城1, 2 , 谢福生3
作者信息
  • 1. 桂林医科大学人文与管理学院，广西 桂林 541199
  • 2. 桂林医科大学财务处，广西 桂林 541199
  • 3.桂林医科大学第二附属医院
通讯作者:
杨兆城，E-mail:
作者简介:

李继宏（1970—），博士，副教授，研究方向：卫生政策与管理

Coupling coordination level and evolution of constraining factors in health expenditure, medical resources, and medical services in China since the new healthcare reform
Ji-hong LI1, Fang ZHANG1, Zhao-cheng YANG1, 2 , Fu-sheng XIE3
Affiliations
  • School of Humanities and Management, Guilin Medical University, Guilin, Guangxi 541199, China
出版时间: 2026-08-10 doi: 10.20043/j.cnki.MPM.202512240
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摘要
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目的

探索新医改以来我国卫生经费投入系统、医疗资源配置系统和医疗服务效率系统耦合协调水平与制约因素，为推进我国医疗服务高质量发展提供参考。

方法

采用耦合协调模型和障碍度模型分析2010—2023年我国31个省份三系统耦合协调度和障碍因子演变。

结果

耦合协调度均值由2010年的0.06提升到2023年的0.52，各省份呈现缓慢上升趋势但未达到中级协调水平（<0.6），青海仅从0.02增至0.31；关键障碍因子障碍度均值从0.10增至0.32，从卫生经费投入系统和医疗资源配置系统的政府投入有限、人力资源队伍建设薄弱等多个指标逐渐演变为医疗服务效率系统的门诊与住院次均费用偏高等两个指标。

结论

我国三系统耦合协调水平有待进一步提高，关键障碍因子由多个投入型指标演变为2个效率型指标。应进一步从针对协调发展短板完善适配政策、优化医疗服务结构降低医疗费用、利用市场机制完善经费投入与利用机制等多方面提高三者协调发展水平。

卫生经费投入  /  医疗资源配置  /  医疗服务效率  /  耦合协调度  /  障碍因子
Objective

To explore the coupling coordination level and limiting factors of the health expenditure input system, the medical resource allocation system, and the health service efficiency system and to provide references for promoting the high-quality development of health services in China since the new healthcare reform.

Methods

The coupling coordination model and obstacle degree model were used to analyze the coupling coordination degree and the evolution of obstacle factors among the three systems in 31 provinces of China from 2010 to 2023.

Results

The average coupling coordination degree increased from 0.06 in 2010 to 0.52 in 2023, showing a slow upward trend but not reaching a moderate coordination level (<0.6). Qinghai only increased from 0.02 to 0.31. The average obstacle degree of the key obstacle factors rose from 0.10 to 0.32. The key obstacle factors gradually shifted from multiple input-related indicators, such as limited government investment and inadequate development of the healthcare workforce, to two efficiency-related indicators: relatively high average outpatient and inpatient costs.

Conclusion

The coupling coordination level of the three systems needs further improvement. The key obstacle factors have evolved from multiple input-based indicators to two efficiency-based ones. It is necessary to further enhance the coordinated development of those systems by diversifying strategies, such as perfecting adaptive policies to address shortcomings in coordinated development, optimizing the structure of medical services to reduce medical costs, and improving health expenditure input and utilization mechanisms through market mechanisms.

Health expenditure  /  Medical resource allocation  /  Health service efficiency  /  Coupling coordination degree  /  Obstacle factor
李继宏, 张方, 杨兆城, 谢福生. 新医改以来我国卫生经费、医疗资源、医疗服务耦合协调水平与障碍因子演变研究. 现代预防医学, 2026 , 53 (15) : 2813 -2819 . DOI: 10.20043/j.cnki.MPM.202512240
Ji-hong LI, Fang ZHANG, Zhao-cheng YANG, Fu-sheng XIE. Coupling coordination level and evolution of constraining factors in health expenditure, medical resources, and medical services in China since the new healthcare reform[J]. Modern Preventive Medicine, 2026 , 53 (15) : 2813 -2819 . DOI: 10.20043/j.cnki.MPM.202512240
正文
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医疗资源合理配置和医疗服务高效利用直接关乎群众医疗需求实现程度，也是国家卫生经费投入的目标和依据。卫生经费、医疗资源和医疗服务形成相互配合、相互促进的同步发展关系，对推动医疗服务高质量发展和有效满足日益增长的医疗需求具有重要意义[1]。2009年《关于深化医药卫生体制改革的意见》政策文件提出为群众提供安全、有效、方便、价廉的医疗服务是今后长期重点改革任务之一，首先要解决三者发展不平衡、不协调、不可持续的问题，这要求根据不同阶段难点调整策略，推进三者从无序演化转变为有序协同发展，达成动态平衡、良性互动的可持续发展格局。因此，研究三者协调发展短板，有利于各省份找准制约协调发展的关键症结，实现卫生经费和医疗资源社会效益最大化，更好地提升医疗服务供给效率，为我国医疗服务高质量发展提供保障。
相关文献主要是围绕医疗资源、医疗服务和区域经济间协同发展水平展开研究，已有研究证明无论是两两系统间还是多系统间存在明显的耦合协调发展关系，不同地区经济发展对医疗资源、医疗服务协调发展有显著促进作用[1-3]。但忽视了卫生经费投入的直接影响，一方面体现为评价指标缺少卫生经费的筹资和分配指标，也缺少卫生经费与医疗资源、医疗服务多系统间协同研究，导致无法真实反映政府投入的调控作用、财政补助情况和筹资责任，另一方面鲜有进一步分析阻碍三者间协调发展的障碍因素，导致对该问题的分析不够全面和精准。鉴于此，本文基于耦合协调模型和障碍度模型，探讨卫生经费投入、医疗资源配置和医疗服务效率的耦合协调程度和关键障碍因子，为我国医疗服务高质量发展提供更具操作性的方向和路径。
1　资料与方法
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1.1　资料来源与指标体系构建
数据来源于2010—2023年《中国卫生统计年鉴》《中国卫生和计划生育统计年鉴》《中国卫生健康统计年鉴》31个省份统计数据。依据统计年鉴将研究区域划分为三个，东部地区11个省份（北京、天津、河北、辽宁、上海、江苏、浙江、福建、山东、广东、海南）、中部地区8个省份（山西、吉林、黑龙江、安徽、江西、河南、湖北、湖南）、西部地区12个省份（内蒙古、广西、重庆、四川、贵州、云南、西藏、陕西、甘肃、青海、宁夏、新疆）。针对2010年上海、海南、四川、西藏、陕西、青海、宁夏和2011年西藏的部分卫生经费数据缺失，通过查阅各省份统计年鉴、相关文献[4]或采用线性插值法[3]补齐。
按照指标选取独立性、科学性、可操作性等原则，参考相关研究构建指标体系。卫生经费投入系统中政府卫生支出占卫生总费用比重、个人卫生支出占卫生总费用比重、卫生总费用占国内生产总值（gross domestic product,GDP）比重、人均卫生费用、床均财政补助等指标直接反映了国家重视程度及保障水平、财政投入在供给端落地情况[4-5]；医疗资源配置系统中三级医院占医院比重、每千人医疗机构床位数、每千人卫生技术人员数、每千人执业（助理）医师数、每千人注册护士数等指标直观反映了优质医疗资源市场规模、物力和人力配置情况[1-2,5]；医疗服务效率系统中每千人诊疗人次、门诊次均医疗费、住院次均医疗费、平均住院日、床均医疗收入等指标较好地反映了该省份就医意愿和需求满足情况、诊疗技术利用与服务流程管理效率等情况[2-3,6-7]。见表1。
1.2　研究方法
1.2.1　熵权法
熵权法是对原始数据进行归一化处理，计算熵值确定指标权重[2]。
1.2.2　耦合协调度模型
耦合协调是指多个系统间通过相互作用共同演进完成特定目标的过程，耦合协调度模型是度量多个系统间协调发展程度[3]，计算公式为：
其中，Ui为该子系统对复合系统有序度的贡献，S为耦合度，值越大子系统关联度越大； T为综合协调指数，α、β、γ为各子系统权重，α+β+γ=1，基于协同发展思想，以往研究认为子系统同等重要[1-3]，故均取1/3；D为耦合协调度，取值范围为[0,1]，将其划分为5个等级[3]。见表2。
1.2.3　障碍度模型
障碍度模型通过计算系统、指标障碍度，识别子系统间耦合协调发展水平制约因素[3]，计算步骤如下：
其中，Fi为因子贡献度，Wj为第j子系统权重，aij为第j系统中第i项指标权重，i=1，2，…，15，j=1，2，3；Ii为指标偏离度，Xi为第i指标归一化值；Hi为指标障碍度，Mj为第j子系统障碍度，Hi与Mj取值越大障碍度越高，取值范围均为[0,1]。
2　结果
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2.1　耦合协调度演变分析
2010年全国与三地区耦合协调度均值低于0.2，为严重失调状态，2011年均超过0.2，进入轻度失调阶段，2016—2023年超过0.4但低于0.6，为初级协调状态。具体来看，东部11个省份2010年有5个为严重失调状态，4个为轻度失调状态，2个为初级协调状态；2011—2023年呈现不同程度缓慢上升，2023年均处于初级协调阶段，但未达到中级协调阶段。中部8个省份2010年有7个为严重失调状态，2011—2023年与东部情况类似。西部12个省份2010年有7个为严重失调状态，5个为轻度失调状态，2011—2023年呈现不同程度缓慢上升，2023年11个省份均处于初级协调阶段，青海仍为轻度失调状态。另外，计算31个省份耦合协调度极差发现，从2010年0.41波动下降至2023年0.21，表明各省份耦合协调度差距明显缩小。总体上，全国各省份耦合协调度呈现缓慢上升趋势且差异显著缩小，但均未达到中级协调水平。见图1。
2.2　三系统障碍度演变分析
2010—2019年全国和三地区的卫生经费投入系统（代码A）、医疗资源配置系统（代码B）、医疗服务效率系统（代码C）障碍度均值从大到小排序都呈现为B、A、C，2020—2023年C障碍度均值最高，A上下波动，B持续下降，三系统呈现相同演变趋势。具体来看，东部11个省份在2010—2019年均呈现A或B障碍度最高，2020—2023年有10个省份C障碍度最高；中部8个省份在2010—2019年间有7个B障碍度最高，2020—2023年4个省份C障碍度始终最高，其他省份C与A、B障碍度交替最高；西部12个省份在2010—2019年基本呈现B障碍度最高，2020—2023年有6个C障碍度最高，其他省份C与A、B障碍度交替最高；另外，2010—2023年青海B和C障碍度接近且均远高于A，宁夏A和C障碍度接近但均远低于B。综上，大部分省份呈现由B或A障碍度最高逐渐演变为C障碍度最高的趋势。见图2。
2.3　障碍因子演变分析
首先，计算并筛选障碍度排名前三的指标，2010—2019年障碍因子障碍度均低于0.20，全国主要障碍因子为B4、A3、B3，东部为B4、B3、B5，中部为B4、B3，西部为B1、B4、B5，均归属于B或A；2020—2023年障碍度超过0.20的障碍因子数量逐渐增加，全国主要障碍因子为C3、C2、A1，东部为C3、C2，中部和西部为C3、A1、C2，均归属于C或A。整体上，2010—2023年归属于B和A的障碍因子障碍度和数量逐渐下降同时归属于C的障碍因子障碍度和数量逐渐增加。另外，床位数和诊疗人次都偏低是青海长期存在的障碍因子。篇幅所限，仅展示全国和3个地区障碍度排名前三的主要障碍因子。见表3，代码见表1。
其次，统计各省份高频次障碍因子（≥3次），2010—2015年全国与三地区的高频次障碍因子均归属于B和A，B4、B3、B5、B1、A1与A5等是关键障碍因子；2016—2018年归属于B和A的障碍因子频次逐渐减少、C3频次逐渐增加；2019—2023年归属于C的C3、C2等障碍因子频次和数量逐渐上升，归属于B和A的频次和数量逐渐减少， 2023年是C3、C2、A1。综上，高频次障碍因子从归属于A和B过渡为归属于C和A，呈现障碍度逐渐提升且障碍因子数量逐渐减少的趋势。见表4。
3　讨论
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3.1　各省份耦合协调度差异逐渐减少且呈缓慢上升趋势，但仍存在较大提升空间
2010—2023年31个省份耦合协调度均呈现缓慢上升且差距逐步缩小的发展趋势，只有青海明显低于其他省份，整体呈现“严重失调为主-轻度失调增多-初级协调为主”演变过程，但均未达到中级协调水平，表明三系统耦合协调水平仍有显著提升空间。可能有两个主要原因：一是由于我国于1979年启动的医疗体制改革实践过度强化了市场化配置医疗资源，导致卫生投入滞后于经济发展、资源配置不合理与医疗服务效率偏低等问题长期存在[8]，这使得2010年我国各省份三者耦合协调水平都处于严重失调状态。二是新医改以来，各级医疗机构的补偿机制与管理与运营机制改革等配套政策陆续实施，有效促进了三者有序协调发展[9]；然而我国人口众多、人均收入水平低以及城乡、区域改革基础和动力差距较大等现实困难，决定了三者协调发展建设是一个长期、渐进过程[10]，这使得自2011年以来各省份耦合协调水平虽有明显改善但仍有待进一步提升。
3.2　关键障碍因子由归属于卫生经费投入系统和医疗资源配置系统演变为归属于医疗服务效率系统，呈现障碍度逐渐提升且数量逐渐减少趋势
首先，2010—2023年全国和三个地区呈现卫生经费投入系统和医疗资源配置系统障碍度逐渐下降、医疗服务效率系统障碍度逐渐上升趋势。其次，关键障碍因子障碍度呈现逐渐提升且数量逐渐减少趋势，由人力资源不足、三级医院数量较低、政府支出占比较低与床均财政补助有限等归属于前二个系统的投入型指标，逐渐演变为医疗服务效率系统的门诊与住院费用偏高等效率型指标，长期存在的政府投入不足情况明显变好。上述结论可能有五个主要原因：一是新医改初期实践并未根本性缓解卫生投入不足与资源分配“倒三角”结构矛盾[9]，形成我国居民就医倾向首选三级医院现象，三级医院普遍超负荷运转，导致我国医疗服务供给与医疗需求失衡问题长期存在，使得我国长期处于卫生经费投入有限、医疗人力资源和三级医院数量相对不足的状态[7]，卫生投入不足和资源配置不合理问题没有明显改善。二是由于管理体制行政化、激励机制不合理等问题短期内难以解决，导致我国人力资源长期处于紧缺状态[11]，新医改以来公立医院不断深化改革，就业环境、职业前景、薪资待遇等问题逐步改善[10]，缓解了人员流失和后备人才转行现象。三是我国政府多年来坚持逐渐增加卫生事业投入总量，同时逐步放宽社会资本进入门槛以增加服务供给主体与规模[12]；这一系列改革缓解了卫生经费投入和医疗资源配置的阻力作用。四是我国城镇化建设、医保全覆盖政策改革等带来刚性且持续增长的医疗服务需求[13]，加剧了医疗费用增长。五是新医改以来我国人均年门诊次数长期低于同期经济合作与发展组织国家均值，但居民年住院率逐渐上升而同期经济合作与发展组织住院率呈下降趋势[14]，医疗服务利用结构失衡也加强了医疗费用攀升趋势，医疗费用相对过高成为当前我国医疗服务高质量发展的主要制约因素。
3.3　建议
首先，因地制宜补齐协调发展短板，持续提升各省份耦合协调水平。提升耦合协调发展水平关键在于通过定期评估各省份经费、资源和服务利用合理性，明确三者发展方向或失衡点，综合考虑各省份地理、人口、经济等因素，针对协调发展短板完善适配政策，补齐短板挖掘发展潜力，并构建政府、卫生部门、医疗机构、居民等多方共治格局，增强三者发展后劲[9]；此外，加强利用远程影像诊断、电子病历共享、远程会诊等信息技术提升偏远省份对口帮扶力度[7]，将有限的卫生经费和医疗资源配置到关键需求点，提升医疗服务质量和利用效率，持续推进三系统同步提升和均衡发展。
其次，优化医疗服务利用结构，多元缓解医疗费用的制约作用。一是明确各级机构实际资源需求量及服务利用情况，开展更多服务利用率高的诊疗项目，加强监管不合规诊疗行为[14]，控制不合理费用支出。二是加强区域医疗中心建设，推进各级机构人才培养和医疗服务同质化，以提升服务质量和医疗技术、健全全临床诊疗管理机制[7]，减少无效成本消耗。三是深化强基层制度建设，提升基层对常见病和多发病的预防、治疗能力，降低重大疾病发生风险[6]，减少不必要医疗支出。四是做好医保结构性改革、医联体建设、医疗服务价格与绩效管理制度改革等政策衔接和优化，系统性完善供需双方激励机制[15]，打破医院诊疗、社区康复与居家照护间壁垒，构建全生命周期的医疗服务体系，替代碎片化、重复性服务，进一步降低医疗费用。
最后，利用市场机制完善经费投入与利用机制，拓展政府投入不足破解路径。一是建立政府主导的多渠道经费投入体系，适当提高政府卫生投入占比的同时，利用市场机制优化社会资本筹资和捐赠环境，形成公益性保障和市场化效率的良性互动[16]，提高政府、社会、医疗机构等多主体经费供给能力，拓宽经费筹资来源。二是完善经费利用机制，利用人群健康结果精细化设计经费分配制度，合理调整投入优先级以缓解经费浪费和利用效率递减[12]，确保经费投入产出持续优化，从根本上破解政府投入不足问题。
本文由于统计数据限制纳入指标不够全面，在后续研究中期待尽可能兼顾科学与全面纳入更多指标，更加深入完善地研究。
基金
收起
  • 中国博士后科学基金面上资助项目(2023M740531)
  • 广西哲学社会科学研究课题(23FYJ029)
  • 广西八桂学者“社会医学与卫生事业管理”岗位基金资助
文献
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2026年第53卷第15期
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doi: 10.20043/j.cnki.MPM.202512240
  • 接收时间：2025-12-14
  • 首发时间：2026-09-28
  • 出版时间：2026-08-10
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  • 收稿日期：2025-12-14
基金
中国博士后科学基金面上资助项目(2023M740531)
广西哲学社会科学研究课题(23FYJ029)
广西八桂学者“社会医学与卫生事业管理”岗位基金资助
作者信息
    1. 桂林医科大学人文与管理学院，广西 桂林 541199
    2. 桂林医科大学财务处，广西 桂林 541199
    3.桂林医科大学第二附属医院

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