兰州大学学报(医学版)

目的 评价2017—2024年兰州市城关区社区基本医疗服务效率，为社区卫生服务机构提质增效提供参考。方法 运用超效率数据包络分析模型测度2024年社区基本医疗服务效率，马尔姆奎斯特指数分析2017—2024年社区基本医疗服务效率的动态变化，结合托宾回归模型探讨投入指标对综合技术效率的影响。结果 分层结果显示，中心综合技术效率、纯技术效率均高于站点，规模效率低于站点。76.67%的超效社区呈规模报酬递减，非有效社区均为规模报酬递增。动态分析表明，2017—2024年中心和站点全要素生产率年均增长4.5%、7.0%。回归分析显示，财政拨款对中心的服务效率具有正向影响，技师配置、业务用房面积产生负向影响（P<0.05）；站点的服务效率主要受注册护士和财政投入的影响（P<0.05）。非有效社区普遍存在业务用房面积及万元以上设备台数投入冗余和门诊人次数及开展中医医疗技术总数产出不足的现象。结论 兰州市城关区社区卫生服务机构基本医疗服务效率整体水平较高，但存在超效社区基本医疗服务效率分布不均衡、非有效社区规模效率不足及资源投入差异化的现象。技术进步是社区基本医疗服务效率提升的关键。

Objective To evaluate the efficiency of basic medical services in community health service institutions in Chengguan District, Lanzhou from 2017 to 2024, and provide references for improving the quality and efficiency in this respect. Methods A super-efficiency data envelopment analysis model was used to measure the efficiency of basic medical services in 2024, and the Malmquist index was combined to analyze the dynamic changes in the efficiency of basic medical services in communities from 2017 to 2024. The Tobit regression model was used to explore the impact of input indicators on the comprehensive technical efficiency. Results The stratified results showed that the mean values of the central comprehensive technical efficiency and pure technical efficiency were both higher than those of the stations, while the mean value of scale efficiency was lower. 76.67% of the super-efficient communities showed decreasing returns to scale, while all non-efficient communities showed increasing returns to scale. Dynamic analysis indicated that the average annual growth rates of total factor productivity in centers and stations were 4.5% and 7.0%, respectively, from 2017 to 2024. Regression analysis revealed that fiscal appropriation had a positive impact on the service efficiency of centers, while the allocation of technicians and the area of business premises had a negative impact(P < 0.05). The service efficiency of stations was mainly affected by availability in the number of registered nurses and fiscal input(P < 0.05). Non-efficient communities generally had redundant input in the area of business premises and the number of equipment worth more than 10 000 yuan, as well as insufficient output in the number of outpatient visits and the total number of traditional Chinese medical techniques. Conclusion The overall level of basic medical service efficiency in community health service institutions in Chengguan District, Lanzhou is relatively high, but there are imbalances in the distribution of basic medical service efficiency in super-efficient communities, insufficient scale efficiency in non-efficient communities, and differences in resource input. Technological progress is the key to improving the efficiency of basic medical services in communities.