公立医疗卫生机构资源水平对私立医疗卫生机构发展的影响(2002—2017)：基于门槛回归

目的：通过对公立和非公立医疗卫生机构在2002—2017年的资源分布及其影响因素进行实证分析，判断两类机构之间的关系，结合社会办医政策进一步探究实证结果，提出适宜我国医疗服务体系多元提供主体的合理建议。方法：采用动态时间规整法刻画公立与私立医疗卫生机构的联合趋势对比；通过门槛分析探索公立医疗卫生机构的不同资源水平对私立医疗卫生机构资源量的影响。结果：公立医疗卫生机构在2009年达到46万家之后，私立机构数随着公立机构数的下降呈现增长趋势，床位数和以医生数、护士数为代表的人员数则与公立机构保持共同增长的态势。公立医疗卫生机构数2009年达到的46万是若干影响因素共同的门槛值，公立床位数2010年达到的437.5万张是诊疗人次数的门槛值。公立医生数在200万左右的一定区间内改善若干影响因素最有利于私立医生数的增加。结论：2009年后，公、私立医疗卫生机构在数量上呈现“竞争”关系，而床位数、人员数呈现“共生”关系。建议社会办医政策下一步重点为拓展私立医疗卫生机构“生态位宽度”，同时给予宽松政策提升人员数量，以促进医疗卫生资源的均衡分布以及健康产业发展。

Influence of resource level of public health institutions on the development of private health institutions (2002-2017): Based on threshold regression

Objective:To analyze the resources distribution and its influencing factors between public and non-public health institutions, using published data during the period from 2002 to 2017. The effects of previous policies were further discussed and advices were put forward for the diversification of the medical system in China. Methods:The dynamic time warping method was used to depict the joint trend comparison chart fed of data from public and non-public institutions. Then, through the threshold analysis, the potential change of influence of public resources on increase of non-public ones was detected. Results:When the total number of public health institutions reached about 460 000 in 2009, and the private health institutions showed an increase in number. However, the number of beds and that of staff represented by doctors and nurses maintained growth in their own trends in public institutions. The number of 460 000 public health institutions reached in 2019 was the common threshold for several influencing factors, and the 4 375 000 public beds reached in 2010 are the only threshold for the number of clinics. Nonetheless, the number of public doctors was most favorable to improving several influencing factors, which conducted to the increase of the number of private doctors within a certain range of about 2 million. Conclusions:Since 2009, public and private health institutions have shown a competitive relationship in terms of the number, while the number of beds and personnel still maintains a symbiotic growth. It is suggested that the private capital should invest on more diversified areas including the long-term care, fertility facilitation, nursing home, physical examination and rehabilitation in order to expand the ecological width of private health institutions. In the same time, the loose policy should be granted to promote health staff entering the non-public health institutions, for the purpose of a more balanced distribution of health resources and the development of the industry as a whole.