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Article(id=1240395009204212074, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202502274, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1740067200000, receivedDateStr=2025-02-21, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773662815618, onlineDateStr=2026-03-16, pubDate=1753372800000, pubDateStr=2025-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773662815618, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773662815618, creator=13701087609, updateTime=1773662815618, updator=13701087609, issue=Issue{id=1240395006914130733, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='14', pageStart='2497', pageEnd='2688', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773662815073, creator=13701087609, updateTime=1773662858015, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240395187109810535, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240395187109810536, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2582, endPage=2587, ext={EN=ArticleExt(id=1240395009451676014, articleId=1240395009204212074, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of the operational efficiency of primary care organizations in pilot counties of close-knit county medical community construction, Sichuan, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the operational efficiency of primary care organizations in the pilot counties of close-knit county medical communities in Sichuan Province, and to provide a reference for continuing to promote the high-quality development of close-knit county medical communities across the country and help build a more synergistic and efficient county medical service network.

Methods

Primary care organizations in 37 pilot counties in Sichuan Province were used for the study, and data envelopment analysis and Malmquist index model were used for static and dynamic measurement of operational efficiency, respectively.

Results

The mean values of comprehensive efficiency, pure technical efficiency, and scale efficiency of primary care organizations in pilot counties in Sichuan Province in 2022 were 0.806, 0.936, and 0.863, respectively. Among them, the operational efficiencies of Wenchuan (0.314), Jiuzhaigou (0.226), Seda (0.116), and Ganzi (0.061) were located below 0.400. Compared with 2018, their comprehensive efficiency and pure technical efficiency have improved, while scale efficiency was flat. The mean value of the total factor productivity index of primary care organizations in the pilot counties from 2018 to 2022 was 0.975. Further decomposing the total factor productivity index, the mean values of the technical efficiency index, the technical progress index, the pure technical efficiency index, and the scale efficiency index were 1.014, 0.962, 1.022, and 0.992, respectively.

Conclusion

After the implementation of the policy, the operational efficiency of primary care organizations in the pilot counties of Sichuan Province showed significant improvement, but there is still much room for improvement, and the differences between counties are more obvious. In the future, we should focus on the technical progress and scale efficiency, strengthen the continuing medical education of primary medical personnel, innovate and carry out the new technology of primary characteristics, and reasonably balance and effectively allocate the medical resources in the counties.

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目的

探析四川省紧密型县域医共体建设试点县基层医疗机构的运行效率，为全国各地持续推动紧密型县域医共体高质量发展，助力构建更协同、高效的县域医疗服务网提供参考。

方法

以四川省37个试点县的基层医疗机构为研究对象，采用数据包络分析与Malmquist指数模型分别进行运行效率的静态与动态测度。

结果

2022年四川省试点县基层医疗机构的综合效率、纯技术效率、规模效率均值分别为0.806、0.936、0.863。其中汶川县（0.314）、九寨沟县（0.226）、色达县（0.116）、甘孜县（0.061）的运行效率均位于0.400以下。与2018年比较，其综合效率与纯技术效率均有所提升，而规模效率持平。2018—2022年试点县基层医疗机构的全要素生产率指数均值为0.975。进一步分解全要素生产率指数，技术效率指数、技术进步指数、纯技术效率指数、规模效率指数的均值分别为1.014、0.962、1.022、0.992。

结论

政策实施后，四川省试点县基层医疗机构的运行效率呈现明显改善，但仍有较大改进空间，且县域间差异较为明显。未来一定时期应重点关注技术进步与规模效率，加强基层医务人员继续医学教育，创新开展基层特色新技术，合理均衡且有效配置县域医疗资源。

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马原，E-mail：
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周玄平（1986—），女，硕士，高级会计师，研究方向：运营管理，卫生政策

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周玄平（1986—），女，硕士，高级会计师，研究方向：运营管理，卫生政策

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(In Chinese), articleTitle=A study on the operational efficiency of county-level medical and health sub-centers in Sichuan Province based on data envelopment analysis, refAbstract=null), Reference(id=1240413545314186016, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, doi=null, pmid=null, pmcid=null, year=2020, volume=37, issue=9, pageStart=670, pageEnd=673, url=null, language=null, rfNumber=［22］, rfOrder=40, authorNames=李姣姣, 李妍君, 魏来, journalName=中国卫生事业管理, refType=null, unstructuredReference=李姣姣，李妍君，魏来，等．基层卫生人力资源管理存在的关键问题与调整策略[J].中国卫生事业管理，2020,37(9):670-673., articleTitle=基层卫生人力资源管理存在的关键问题与调整策略, refAbstract=null), Reference(id=1240413545440015143, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, doi=null, pmid=null, pmcid=null, year=2020, volume=37, issue=9, pageStart=670, pageEnd=673, url=null, language=null, rfNumber=［22］, rfOrder=41, authorNames=Li JJ, Li YJ, Wei L, journalName=Chinese Health Service Management, refType=null, unstructuredReference=Li JJ, Li YJ, Wei L, et al. Studying on the key issues of grassroots health human resources management and its adjustment strategies[J]. Chinese Health Service Management, 2020,37(9): 670-673. (In Chinese), articleTitle=Studying on the key issues of grassroots health human resources management and its adjustment strategies, refAbstract=null), Reference(id=1240413545582621486, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, doi=null, pmid=null, pmcid=null, year=2013, volume=45, issue=2, pageStart=264, pageEnd=268, url=null, language=null, rfNumber=［23］, rfOrder=42, authorNames=张桂林, 潘习龙, journalName=北京大学学报:医学版, refType=null, unstructuredReference=张桂林，潘习龙．基于数据包络分析方法的北京市农村基本公共卫生服务项目效率评价[J].北京大学学报:医学版，2013,45(2):264-268., articleTitle=基于数据包络分析方法的北京市农村基本公共卫生服务项目效率评价, refAbstract=null), Reference(id=1240413545729422135, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, doi=null, pmid=null, pmcid=null, year=2013, volume=45, issue=2, pageStart=264, pageEnd=268, url=null, language=null, rfNumber=［23］, rfOrder=43, authorNames=Zhang GL, Pan XL, journalName=Journal of Peking University(Health Sciences), refType=null, unstructuredReference=Zhang GL, Pan XL. Evaluating the efficiency of basic public health service project in Beijing rural areas based on data envelopment analysis[J]. Journal of Peking University(Health Sciences), 2013, 45(2): 264-268. (In Chinese), articleTitle=Evaluating the efficiency of basic public health service project in Beijing rural areas based on data envelopment analysis, refAbstract=null)], funds=[Fund(id=1240413537324036524, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, awardId=SWFZ23-Q-77, language=CN, fundingSource=四川省基层卫生事业发展研究中心青年项目(SWFZ23-Q-77), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240413531900801168, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, xref=1., ext=[AuthorCompanyExt(id=1240413531909189777, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, companyId=1240413531900801168, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1240413531913384082, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, companyId=1240413531900801168, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川大学华西第四医院，四川 成都 610041)]), AuthorCompany(id=1240413532018241685, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, xref=2., ext=[AuthorCompanyExt(id=1240413532026630295, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, companyId=1240413532018241685, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川大学华西第二医院)])], figs=[ArticleFig(id=1240413535923138868, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, language=EN, label=Fig.1, caption=Composition of remuneration for scale of operational efficiency of primary care organizations in pilot counties in Sichuan Province, figureFileSmall=zmtF9OwOBqziOv4Qiw1u9A==, figureFileBig=ilPNdFnRywf3hT08CgMLsA==, tableContent=null), ArticleFig(id=1240413536044773696, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, language=CN, label=图1, caption=四川省试点县基层医疗机构运行效率规模报酬构成情况, figureFileSmall=zmtF9OwOBqziOv4Qiw1u9A==, figureFileBig=ilPNdFnRywf3hT08CgMLsA==, tableContent=null), ArticleFig(id=1240413536183185740, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, language=EN, label=Fig.2, caption=Composition of relative effectiveness of operational efficiency of primary care organizations in pilot counties in Sichuan Province, figureFileSmall=fEcSF+V4uycUR1SpJ1pKGQ==, figureFileBig=+vySsuy3PfpgWZeXshVd5Q==, tableContent=null), ArticleFig(id=1240413536275460440, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, language=CN, label=图2, caption=四川省试点县基层医疗机构运行效率相对有效性构成情况, figureFileSmall=fEcSF+V4uycUR1SpJ1pKGQ==, figureFileBig=+vySsuy3PfpgWZeXshVd5Q==, tableContent=null), ArticleFig(id=1240413536392900962, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, language=EN, label=Table 1, caption=

Results of static analysis of the operational efficiency of primary healthcare organizations in pilot counties in Sichuan Province

, figureFileSmall=null, figureFileBig=null, tableContent=
地区2018年2022年
综合效率纯技术效率规模效率综合效率纯技术效率规模效率
新都区0.8870.9550.9290.9431.0000.943
青白江区0.9270.9780.9480.9581.0000.958
邛崃市0.9531.0000.9530.9070.9450.960
新津县1.0001.0001.0001.0001.0001.000
蒲江县1.0001.0001.0001.0001.0001.000
贡井区0.8350.9050.9230.8600.9100.946
自流井区1.0001.0001.0001.0001.0001.000
米易县1.0001.0001.0001.0001.0001.000
盐边县0.6270.7860.7980.6690.9760.685
泸县0.7240.7310.9910.9340.9710.961
合江县0.6560.6590.9950.6850.7290.940
绵竹市1.0001.0001.0001.0001.0001.000
广汉市1.0001.0001.0001.0001.0001.000
中江县0.8210.8420.9740.9181.0000.918
罗江区0.9641.0000.9640.8930.9500.939
平武县0.5410.6720.8040.9841.0000.984
朝天区0.5140.6300.8170.6350.7440.853
安居区0.6880.7120.9650.7680.7820.982
隆昌市0.7440.8230.9040.9360.9460.989
沐川县0.8841.0000.8840.7900.9080.870
顺庆区0.9731.0000.9730.9981.0000.998
兴文县0.5230.5560.9400.7250.7370.984
江安县0.6680.6830.9771.0001.0001.000
筠连县0.5960.6700.8900.8980.9170.980
广安区0.6360.6610.9620.9010.9030.998
华蓥市0.7020.7900.8890.8020.8630.929
通川区0.6810.7440.9160.7420.7980.930
平昌县0.7190.7280.9880.8610.8610.999
石棉县0.7921.0000.7920.7641.0000.764
青神县0.8631.0000.8630.7450.9210.809
安岳县1.0001.0001.0001.0001.0001.000
汶川县0.4370.9580.4560.3141.0000.314
九寨沟县0.3381.0000.3380.2261.0000.226
甘孜县0.0760.8680.0880.0610.8880.069
色达县0.2121.0000.2120.1161.0000.116
德昌县0.5690.7190.7920.7850.8870.885
西昌市1.0001.0001.0001.0001.0001.000
均值0.7450.8670.8630.8060.9360.863
), ArticleFig(id=1240413536518730092, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, language=CN, label=表1, caption=

四川省试点县基层医疗机构运行效率静态分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
地区2018年2022年
综合效率纯技术效率规模效率综合效率纯技术效率规模效率
新都区0.8870.9550.9290.9431.0000.943
青白江区0.9270.9780.9480.9581.0000.958
邛崃市0.9531.0000.9530.9070.9450.960
新津县1.0001.0001.0001.0001.0001.000
蒲江县1.0001.0001.0001.0001.0001.000
贡井区0.8350.9050.9230.8600.9100.946
自流井区1.0001.0001.0001.0001.0001.000
米易县1.0001.0001.0001.0001.0001.000
盐边县0.6270.7860.7980.6690.9760.685
泸县0.7240.7310.9910.9340.9710.961
合江县0.6560.6590.9950.6850.7290.940
绵竹市1.0001.0001.0001.0001.0001.000
广汉市1.0001.0001.0001.0001.0001.000
中江县0.8210.8420.9740.9181.0000.918
罗江区0.9641.0000.9640.8930.9500.939
平武县0.5410.6720.8040.9841.0000.984
朝天区0.5140.6300.8170.6350.7440.853
安居区0.6880.7120.9650.7680.7820.982
隆昌市0.7440.8230.9040.9360.9460.989
沐川县0.8841.0000.8840.7900.9080.870
顺庆区0.9731.0000.9730.9981.0000.998
兴文县0.5230.5560.9400.7250.7370.984
江安县0.6680.6830.9771.0001.0001.000
筠连县0.5960.6700.8900.8980.9170.980
广安区0.6360.6610.9620.9010.9030.998
华蓥市0.7020.7900.8890.8020.8630.929
通川区0.6810.7440.9160.7420.7980.930
平昌县0.7190.7280.9880.8610.8610.999
石棉县0.7921.0000.7920.7641.0000.764
青神县0.8631.0000.8630.7450.9210.809
安岳县1.0001.0001.0001.0001.0001.000
汶川县0.4370.9580.4560.3141.0000.314
九寨沟县0.3381.0000.3380.2261.0000.226
甘孜县0.0760.8680.0880.0610.8880.069
色达县0.2121.0000.2120.1161.0000.116
德昌县0.5690.7190.7920.7850.8870.885
西昌市1.0001.0001.0001.0001.0001.000
均值0.7450.8670.8630.8060.9360.863
), ArticleFig(id=1240413536652947830, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, language=EN, label=Table 2, caption=

Changes in total factor productivity index and decomposition of primary care organizations in pilot counties in Sichuan Province

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时段技术效率指数技术进步指数纯技术效率指数规模效率指数全要素生产率指数
2018—20191.0380.9891.0231.0141.026
2019—20201.0090.8881.0240.9850.896
2020—20211.0110.9851.0240.9880.996
2021—20220.9970.9881.0180.9800.985
均值1.0140.9621.0220.9920.975
), ArticleFig(id=1240413536782971267, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, language=CN, label=表2, caption=

四川省试点县基层医疗机构全要素生产率指数变化及分解情况

, figureFileSmall=null, figureFileBig=null, tableContent=
时段技术效率指数技术进步指数纯技术效率指数规模效率指数全要素生产率指数
2018—20191.0380.9891.0231.0141.026
2019—20201.0090.8881.0240.9850.896
2020—20211.0110.9851.0240.9880.996
2021—20220.9970.9881.0180.9800.985
均值1.0140.9621.0220.9920.975
), ArticleFig(id=1240413536917189006, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, language=EN, label=Table 3, caption=

Changes in total factor productivity index and decomposition of primary care organizations in different pilot counties

, figureFileSmall=null, figureFileBig=null, tableContent=
地区技术效率指数技术进步指数纯技术效率指数规模效率指数全要素生产率指数
新都区1.0150.9481.0121.0040.963
青白江区1.0081.0191.0061.0031.028
邛崃市0.9880.9990.9861.0020.987
新津县1.0000.9991.0001.0000.999
蒲江县1.0001.0371.0001.0001.037
贡井区1.0070.9211.0011.0060.928
自流井区1.0000.9701.0001.0000.970
米易县1.0000.9561.0001.0000.956
盐边县1.0160.9801.0560.9630.996
泸县1.0660.9531.0740.9921.015
合江县1.0110.9731.0260.9860.983
绵竹市1.0000.9331.0001.0000.933
广汉市1.0000.9451.0001.0000.945
中江县1.0280.9761.0440.9851.003
罗江区0.9810.9700.9870.9940.952
平武县1.1610.9281.1041.0521.078
朝天区1.0540.9181.0431.0110.968
安居区1.0280.9391.0241.0040.966
隆昌市1.0590.9441.0351.0230.999
沐川县0.9720.9550.9760.9960.929
顺庆区1.0060.9681.0001.0060.975
兴文县1.0850.9541.0731.0121.035
江安县1.1060.9541.1001.0061.055
筠连县1.1080.9441.0821.0241.046
广安区1.0910.9151.0811.0090.998
华蓥市1.0340.9651.0221.0110.997
通川区1.0220.9471.0181.0040.968
平昌县1.0460.9601.0431.0031.005
石棉县0.9910.9441.0000.9910.936
青神县0.9640.9430.9800.9840.909
安岳县1.0000.9511.0001.0000.951
汶川县0.9210.9701.0110.9110.893
九寨沟县0.9040.9771.0000.9040.884
甘孜县0.9450.9911.0060.9400.937
色达县0.8590.9911.0000.8590.852
德昌县1.0840.9601.0541.0281.040
西昌市1.0000.9911.0001.0000.991
均值1.0140.9621.0220.9920.975
), ArticleFig(id=1240413537097544090, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395009204212074, language=CN, label=表3, caption=

不同试点县基层医疗机构全要素生产率指数变化及分解情况

, figureFileSmall=null, figureFileBig=null, tableContent=
地区技术效率指数技术进步指数纯技术效率指数规模效率指数全要素生产率指数
新都区1.0150.9481.0121.0040.963
青白江区1.0081.0191.0061.0031.028
邛崃市0.9880.9990.9861.0020.987
新津县1.0000.9991.0001.0000.999
蒲江县1.0001.0371.0001.0001.037
贡井区1.0070.9211.0011.0060.928
自流井区1.0000.9701.0001.0000.970
米易县1.0000.9561.0001.0000.956
盐边县1.0160.9801.0560.9630.996
泸县1.0660.9531.0740.9921.015
合江县1.0110.9731.0260.9860.983
绵竹市1.0000.9331.0001.0000.933
广汉市1.0000.9451.0001.0000.945
中江县1.0280.9761.0440.9851.003
罗江区0.9810.9700.9870.9940.952
平武县1.1610.9281.1041.0521.078
朝天区1.0540.9181.0431.0110.968
安居区1.0280.9391.0241.0040.966
隆昌市1.0590.9441.0351.0230.999
沐川县0.9720.9550.9760.9960.929
顺庆区1.0060.9681.0001.0060.975
兴文县1.0850.9541.0731.0121.035
江安县1.1060.9541.1001.0061.055
筠连县1.1080.9441.0821.0241.046
广安区1.0910.9151.0811.0090.998
华蓥市1.0340.9651.0221.0110.997
通川区1.0220.9471.0181.0040.968
平昌县1.0460.9601.0431.0031.005
石棉县0.9910.9441.0000.9910.936
青神县0.9640.9430.9800.9840.909
安岳县1.0000.9511.0001.0000.951
汶川县0.9210.9701.0110.9110.893
九寨沟县0.9040.9771.0000.9040.884
甘孜县0.9450.9911.0060.9400.937
色达县0.8590.9911.0000.8590.852
德昌县1.0840.9601.0541.0281.040
西昌市1.0000.9911.0001.0000.991
均值1.0140.9621.0220.9920.975
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四川省紧密型县域医共体建设试点县基层医疗机构运行效率分析
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周玄平 1 , 马原 2
现代预防医学 | 卫生政策与管理 2025,52(14): 2582-2587
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现代预防医学 | 卫生政策与管理 2025, 52(14): 2582-2587
四川省紧密型县域医共体建设试点县基层医疗机构运行效率分析
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周玄平1, 马原2
作者信息
  • 1.四川大学华西第四医院，四川 成都 610041
  • 2.四川大学华西第二医院

    • 周玄平（1986—），女，硕士，高级会计师，研究方向：运营管理，卫生政策

通讯作者:

马原，E-mail：
Analysis of the operational efficiency of primary care organizations in pilot counties of close-knit county medical community construction, Sichuan
Xuan-ping ZHOU1, Yuan MA2
Affiliations
  • West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2025-07-25 doi: 10.20043/j.cnki.MPM.202502274
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摘要
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目的

探析四川省紧密型县域医共体建设试点县基层医疗机构的运行效率，为全国各地持续推动紧密型县域医共体高质量发展，助力构建更协同、高效的县域医疗服务网提供参考。

方法

以四川省37个试点县的基层医疗机构为研究对象，采用数据包络分析与Malmquist指数模型分别进行运行效率的静态与动态测度。

结果

2022年四川省试点县基层医疗机构的综合效率、纯技术效率、规模效率均值分别为0.806、0.936、0.863。其中汶川县（0.314）、九寨沟县（0.226）、色达县（0.116）、甘孜县（0.061）的运行效率均位于0.400以下。与2018年比较，其综合效率与纯技术效率均有所提升，而规模效率持平。2018—2022年试点县基层医疗机构的全要素生产率指数均值为0.975。进一步分解全要素生产率指数，技术效率指数、技术进步指数、纯技术效率指数、规模效率指数的均值分别为1.014、0.962、1.022、0.992。

结论

政策实施后，四川省试点县基层医疗机构的运行效率呈现明显改善，但仍有较大改进空间，且县域间差异较为明显。未来一定时期应重点关注技术进步与规模效率，加强基层医务人员继续医学教育，创新开展基层特色新技术，合理均衡且有效配置县域医疗资源。

紧密型县域医共体  /  基层医疗机构  /  运行效率  /  DEA模型  /  Malmquist指数
Objective

To explore the operational efficiency of primary care organizations in the pilot counties of close-knit county medical communities in Sichuan Province, and to provide a reference for continuing to promote the high-quality development of close-knit county medical communities across the country and help build a more synergistic and efficient county medical service network.

Methods

Primary care organizations in 37 pilot counties in Sichuan Province were used for the study, and data envelopment analysis and Malmquist index model were used for static and dynamic measurement of operational efficiency, respectively.

Results

The mean values of comprehensive efficiency, pure technical efficiency, and scale efficiency of primary care organizations in pilot counties in Sichuan Province in 2022 were 0.806, 0.936, and 0.863, respectively. Among them, the operational efficiencies of Wenchuan (0.314), Jiuzhaigou (0.226), Seda (0.116), and Ganzi (0.061) were located below 0.400. Compared with 2018, their comprehensive efficiency and pure technical efficiency have improved, while scale efficiency was flat. The mean value of the total factor productivity index of primary care organizations in the pilot counties from 2018 to 2022 was 0.975. Further decomposing the total factor productivity index, the mean values of the technical efficiency index, the technical progress index, the pure technical efficiency index, and the scale efficiency index were 1.014, 0.962, 1.022, and 0.992, respectively.

Conclusion

After the implementation of the policy, the operational efficiency of primary care organizations in the pilot counties of Sichuan Province showed significant improvement, but there is still much room for improvement, and the differences between counties are more obvious. In the future, we should focus on the technical progress and scale efficiency, strengthen the continuing medical education of primary medical personnel, innovate and carry out the new technology of primary characteristics, and reasonably balance and effectively allocate the medical resources in the counties.

Close-knit county medical communities  /  Primary care organizations  /  Operational efficiency  /  DEA model  /  Malmquist index
周玄平, 马原. 四川省紧密型县域医共体建设试点县基层医疗机构运行效率分析. 现代预防医学, 2025 , 52 (14) : 2582 -2587 . DOI: 10.20043/j.cnki.MPM.202502274
Xuan-ping ZHOU, Yuan MA. Analysis of the operational efficiency of primary care organizations in pilot counties of close-knit county medical community construction, Sichuan[J]. Modern Preventive Medicine, 2025 , 52 (14) : 2582 -2587 . DOI: 10.20043/j.cnki.MPM.202502274
正文
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县域医共体建设是深化医药卫生体制改革的重要步骤和制度创新[1]。2019年5月，国家卫生健康委、国家中医药管理局联合印发《关于推进紧密型县域医疗卫生共同体建设的通知》（国卫基层函〔2019〕121号），确定567个县（市、区、旗）为紧密型县域医共体试点县，其中包含四川省37个县域。该政策旨在进一步完善县域医疗卫生服务体系，提高县域医疗卫生资源的配置及使用效率，加快提升基层医疗卫生服务能力，推动构建分级诊疗、合理诊治和有序就医的新秩序[2]。基层医疗机构作为县域医疗卫生体系的重要组成部分，其运行情况直接影响医共体的建设效果及政策落实。提升基层医疗机构运行效率，对于优化资源配置、提高服务质量、增强患者就医获得感也具有重要现实意义。目前，针对县域医共体的研究多集中于政策文本、运行效果、医保付费等[3-5]，或是县域整体卫生资源配置效率、牵头医院经济运行效率等[6-7]，但关于县域基层医疗机构运行效率的研究探讨较少。因此，本文以四川省为例，选择37个紧密型县域医共体建设试点县的基层医疗机构为研究对象，采用数据包络分析与Malmquist指数模型分别从静态与动态两个角度探究试点县基层医疗机构的运行效率，旨在为全国各地持续推动紧密型县域医共体高质量发展，构建更协同、高效的县域医疗服务网提供借鉴与参考。
1　资料与方法
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1.1　资源来源
选择四川省37个紧密型县域医共体建设试点县的基层医疗机构为研究对象，分析资料源自2018—2022年《四川卫生健康统计年鉴》。参考既往学者研究[8-9]，同时考虑指标代表性及数据可获得性，选取基层医疗机构的机构数、床位数、卫生人员数作为投入指标，诊疗人次数、入院人次数作为产出指标。
1.2　研究方法
1.2.1　数据包络分析（DEA）
数据包络分析是常用来评价不同决策单元相对有效性的一种非参数方法，且在处理多投入、多产出方面有着独特优势[10]。DEA常见的模型主要包括规模报酬不变的CCR模型以及规模报酬可变的BCC模型[11]。鉴于基层医疗机构运行效率受限于技术水平、管理能力等影响，故本研究选择BCC模型，以37个试点县为决策单元，分别测度2018年、2022年四川省紧密型县域医共体建设试点县基层医疗机构的静态运行效率。效率值越接近于1，表示运行效率越高；效率值=1表示达到DEA有效[12]。
1.2.2　Malmquist指数模型
Malmquist指数模型常使用全要素生产率指数衡量决策单元在不同时期运行效率的变化情况[13]。全要素生产率指数可分解为技术效率指数与技术进步指数，其中技术效率指数可进一步分解为纯技术效率指数与规模效率指数[14]。技术进步指数反映决策单元技术水平影响的效率变化。纯技术效率指数反映决策单元管理能力与技术水平影响的效率变化。规模效率指数反映决策单元规模水平影响的效率变化。本研究采用Malmquist指数模型测度2018—2022年四川省紧密型县域医共体建设试点县基层医疗机构的动态运行效率。若指数值>1表示运行效率呈现上升；指数值=1代表运行效率无变化；指数值<1释义运行效率呈现下降[15-16]。
1.3　统计学方法
利用Excel 2016软件整理投入与产出指标，构建基础数据库。运用Deap 2.1软件测度DEA效率及Malmquist指数。
2　结果
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2.1　四川省试点县基层医疗机构运行效率的静态测度
2022年四川省试点县基层医疗机构的综合效率、纯技术效率、规模效率均值分别为0.806、0.936、0.863。相较于2018年，其综合效率与纯技术效率均有所提升，而规模效率持平。分地区来看，2022年基层医疗机构综合效率、纯技术效率、规模效率高于整体平均水平的县域数量占比分别是59.46%、62.16%、78.38%，较2018年分别增加10.81%、5.41%、2.70%，代表性县域如米易县、绵竹市、安岳县等。反之，低于整体平均水平的代表性县域有德昌县、中江县、汶川县等。见表1。
2.2　四川省试点县基层医疗机构运行效率规模报酬构成情况
2022年基层医疗机构运行效率规模报酬递增、不变及递减的县域占比分别为51.35%、24.32%、24.32%。相较于2018年，规模报酬递增的县域占比减少10.81%，而规模报酬不变及递减的县域占比分别增加2.70%、8.11%。见图1。
2.3　四川省试点县基层医疗机构运行效率相对有效性构成情况
2022年基层医疗机构运行效率有效、弱有效及无效的县域占比分别为24.32%、24.32%、51.35%。相较于2018年，DEA有效、弱有效的县域占比均增加2.70%，而DEA无效的县域占比减少5.41%。见图2。
2.4　四川省试点县基层医疗机构运行效率的动态测度
2018—2022年四川省试点县基层医疗机构运行效率的全要素生产率指数先降低后升高再降低。五年间全要素生产率指数均值为0.975，表明运行效率总体呈现下降趋势，年均下降2.5%。进一步分解全要素生产率指数，技术效率指数、技术进步指数、纯技术效率指数、规模效率指数的均值分别为1.014、0.962、1.022、0.992，提示技术进步与规模效率呈现下降趋势，也是影响效率提升的主要因素。见表2。
五年间，27.03%的县域全要素生产率指数大于1，而72.97%的县域小于1。观之全要素生产率指数分解情况，邛崃市、罗江区、沐川县等9个县域的技术效率指数呈现下降，占24.32%。新都区、邛崃市、新津县等35个县域的技术进步指数呈现下降，占94.59%。邛崃市、罗江区、沐川县等4个县域的纯技术效率指数呈现下降，占10.81%。盐边县、泸县、合江县等12个县域的规模效率指数呈现下降，占32.43%。见表3。
3　讨论
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本研究运用数据包络分析与Malmquist指数模型，分别从静态与动态两个角度探讨了四川省37个紧密型县域医共体试点县基层医疗机构的运行效率。研究发现，2022年试点县基层医疗机构运行效率均值为0.806，还有较大进步空间。但相较于2018年政策实施前，运行效率已呈现明显改善。这与臧梓彤等[17]分析广西乡镇卫生院的研究结果较为一致。分析原因，运行效率改善主要源于纯技术效率提升，可能是基层医疗机构在自身管理能力与技术水平方面做出了努力，获得了一定成效。值得注意的是，基层医疗机构的规模效率并未得到同步提升。政策实施前后规模效率均值同为0.863，2022年规模报酬递增及递减的县域分别占51.35%、24.32%。前述分析揭示了现阶段应重点关注基层医疗机构的规模效率问题，同时从管理能力与技术水平方面持续提升纯技术效率，二者并轨而行共促运行效率提升。因此，一是建议对于规模报酬递增的县域基层医疗机构，可在区域卫生规划顶层设计下，适当增加人财物等医疗资源投入，满足居民多方面多层次的健康需求，实现供需平衡[18]。二是对于规模报酬递减的县域基层医疗机构，应缩小规模水平，减少无效投入，避免无序扩张及资源浪费，实现帕累托最优[19]。三是依托上级医疗机构的优质医疗资源，通过专业指导与合作，逐渐提升基层医务人员的业务技术与管理水平，使得临床操作规范化、人事绩效管理科学化[17]。
深入分析具体县域，本研究还发现2022年37个试点县基层医疗机构运行效率值介于0.061～1.000，其中汶川县（0.314）、九寨沟县（0.226）、色达县（0.116）、甘孜县（0.061）均位于0.400以下，提示当前基层医疗机构运行效率的县域差异较为明显，区域发展不平衡，尤其是民族地区。究其原因，县域间基层医疗机构资源配置不均衡，未考虑多种因素，导致在某些县域医疗资源投入过剩或不足，如地区经济水平差异将直接影响资源支持[20]。此处民族地区运行效率低下就归结于资源投入不足，从而引发规模效率低下。因此，建议卫生健康部门应综合考量县域经济发展水平、居民健康需求及疾病谱状况，科学合理制定卫生发展规划，实现医疗资源配置均衡性，不断缩小县域基层医疗机构运行效率差异。
技术进步不足与规模效率下降是制约试点县基层医疗机构运行效率提升的主要因素。本研究按时段与县域统计分析的Malmquist指数模型均显示技术进步指数与规模效率指数均值均小于1，这与马超等分析广东省试点县基层医疗机构的结果相反[6]。可能是源于四川与广东两省经济发展水平、居民健康需求以及地理因素等方面存在显著差异。技术进步指数与规模效率指数分别代表试点县基层医疗机构的技术水平与规模水平。这在一定程度上说明只有技术与规模并重，才能双轮驱动并持续提升试点县基层医疗机构的运行效率。因此，一方面建议加大对基层医务人员的继续教育力度，通过对口帮扶等多种方式结合，以此提升其临床技能水平与知识更新速度[21]。另一方面，不断完善人才引进及激励机制，培养基层医疗机构自身的卫生技术骨干[22]，并切实发挥骨干人员的技术优势，开展具有基层特色的新技术和新策略，提升医疗服务水平。此外，在实际运行过程中，基层医疗机构需关注规模效率，避免盲目投入人力物力及财力[23]，造成资源浪费，竭力实现规模效益最大化。
综上所述，四川省紧密型县域医共体建设试点以来，总体上试点县基层医疗机构的运行效率得到明显改善，但仍有较大改进空间。县域间基层医疗机构运行效率的差异较为明显，发展不均衡现象较为突出。未来一定时期，重点应关注技术进步与规模效率，加强基层医务人员继续医学教育，创新开展基层特色新技术，合理均衡且有效配置县域医疗资源，从而持续提升试点县基层医疗机构运行效率，促进紧密型县域医共体高质量发展。
基金
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  • 四川省基层卫生事业发展研究中心青年项目(SWFZ23-Q-77)
文献
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2025年第52卷第14期
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doi: 10.20043/j.cnki.MPM.202502274
  • 接收时间：2025-02-21
  • 首发时间：2026-03-16
  • 出版时间：2025-07-25
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  • 收稿日期：2025-02-21
基金
四川省基层卫生事业发展研究中心青年项目(SWFZ23-Q-77)
作者信息
    1.四川大学华西第四医院，四川 成都 610041
    2.四川大学华西第二医院

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