我国疾病预防控制机构实验室仪器设备配置评价研究
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摘要
一、研究目的和意义
(一)疾病预防控制体系建设进程的客观需要
2003年非典疫情的发生,暴露出我国疾病预防控制体系中存在的诸多深层次的问题,党中央、国务院明确提出了加强公共卫生体系建设的目标任务,力争用三年时间基本建成覆盖城乡、功能完善的疾病预防控制体系。为了实现此项目标,国家采取了一系列重大措施,开展了全面、系统的疾病预防控制体系建设工作。疾病预防控制体系建设已经纳入国家发展规划,成为构建和谐社会的重要任务之一。疾病预防控制事业面临着前所未有的发展机遇。
在国债项目的引导下,全国各级投入116个亿建设疾病预防控制中心,改善了基础设施和工作条件;国家财政也明显加大了对重大疾病预防专项经费的支持力度,加大人员培训和相应措施的落实力度,2004年起在全国范围内开展了37种传染病和突发公共卫生事件网络直报试运行。整个社会的大环境为疾病预防控制体系建设和发展提供了十分有利的条件,全社会都来参与疾病预防控制工作的观念为越来越多的人接受。
如何系统评价疾病预防控制体系三年建设进展,分析体系建设预期目标达成的程度,剖析体系建设过程中存在的问题与面临的挑战,是管理科学化和决策科学化的需要,也是巩固、发展体系建设成果和完善体系建设的需要。
本研究为“疾病预防控制体系建设系列评价研究”的分课题之一,在整个疾病预防控制体系建设研究中起着重要的作用。实验室仪器设备作为机构运行的硬件基础,保证机构能够开展传染病、地方病和寄生虫病的预防控制,防范生物化学恐怖,调查、控制、处理突发公共卫生事件以及为公共卫生监督提供技术支撑和服务,实验室仪器设备配置状况和水平直观上反映了疾病预防控制体系的建设成效,间接影响了疾病预防控制体系人力资源、公共卫生职能等相关部分的建设水平。对地区疾病预防控制体系建设的评价必须要评价其实验室仪器设备的建设情况。
(二)《省、地、县级疾病预防控制中心实验室建设指导意见》实施评价实验室检验检测与评价是疾病预防控制机构的重要职责,其具体任务包括:开展疾病和健康相关危害因素的生物、物理、化学因子检测,传染病病原学分离鉴定、疾病危害因素实验室诊断、中毒事件的毒物分析与鉴定和毒理学评价,为突发公共卫生事件的应急处置、疾病和健康相关危害因素的预防控制及卫生监督执法等提供技术支持。
适宜的实验室仪器设备配置对于疾病预防控制机构实现实验室检验检测与评价职能具有重要作用。
卫生部、国家发改委于2004年7月下发的《省、地、县级疾病预防控制中心实验室建设指导意见》(以下称《指导意见》),明确提出了实验室建设要求及其装备和检验人员能力要求,有力地推动了硬件建设和实验室规范化建设与发展。在《指导意见》中的《省、地、县级疾病预防控制机构实验室主要仪器装备标准》(以下简称《装备标准》)明确将仪器设备分成完成常规工作所需仪器设备(A类)、按照基本功能必须装备的基本仪器设备(B类)和根据地域特点、工作需求应装备的基本仪器设备三类(C类)。这结合了疾病预防控制机构的工作实际和未来发展需要。各级疾病预防控制机构对《装备标准》的实施情况如何,以及如何进行评价也成为本研究重要的研究背景和目的,通过对仪器装备的评价,评价政策实施成效,摸清薄弱环节,为各级疾病预防控制机构的装备规划和卫生行政部门决策提供科学依据。
(三)建立一套评价疾病预防控制机构实验室仪器设备配置的方法
仪器种类繁多,功能不一,如何对它的配置水平进行评价是卫生管理者和卫生决策者关心的问题。对大型医用设备配置评价可以从配置效率、配置公平、卫生技术评估等方面入手,但对疾病预防控制等公共卫生领域实验室设备评价的研究和实践不足。
本研究借鉴对大型医用设备配置公平性的评价方法,对实验室仪器设备配置的地区均衡性作了分析;运用层次分析法、模糊综合评价等方法,对省级机构实验室仪器设备建设程度进行了综合评价,并对评价结果的合理性进行初步验证,为市县疾病预防控制机构,也为公共卫生领域的仪器设备建设的综合评价方法提供了借鉴。
本次研究,旨在在评价疾病预防控制机构实验室仪器设备配置状况的基础上,探讨疾病预防控制机构实验室仪器设备配置的影响因素,为进一步提高疾病预防控制机构实验室设备建设,落实公共卫生能力提供循证依据。
二、材料与方法
本研究以“卫生系统宏观模型”和“政策制定科学程序”作为指导性研究方法,运用“定性定量多重论证”方法对疾病预防控制机构实验室仪器设备配置的方法和内容进行完善和论证,通过纵向历史比较、地区间横向比较、与标准比较等方法研究机构实验室仪器设备配置的变化情况和达标情况,运用层次分析法、模糊综合评价法对机构实验室仪器设备配置的总体情况进行评价;通过计量经济学等方法探索影响机构实验室仪器设备配置程度的因素。
主要的资料收集方法包括文献归纳法、机构基本情况调查等。省级地区普查,市级地区和县级地区系统抽样。采用“配对比较的样本含量计算公式”确定样本容最。省级调查表回收率为88%,市级调查表回收率为94%,县级调查表回收率为95%,分别回收了28、177、566份调查表。调查的主要内容有样本机构2002年和2005年登记在册的特定实验室仪器设备的实有数量、样本机构每年获得的设备投入、样本机构所在地区社会经济基本情况等信息。
三、主要研究结果
(一)各级疾病预防控制机构设备配置数量有了很大改观,配置趋于完善,但机构设备配置率仍然较低
三年体系建设后,不同地区各级疾病预防控制机构的设备种类数都有所增加,尤其县级的增长比例最大,为38.1%。就同一级别不同地区机构设备配置数量增幅而言,省级、市级最大在东部,县级最大在西部。就机构A、B、C三类仪器设备的配置率而言,省级机构主要是B类仪器设备的增加,增长率为8.4%,特别地,东部省级机构C类仪器设备的增幅是最大的(提高了12.8%):市县两级机构主要是A类仪器设备的增加,分别为提高了7.6%和10.5%。
经过三年体系建设,平均每省级疾病预防控制机构的设备配置数为69-104种,市级疾病预防控制机构平均为29-48种,县级疾病预防控制机构为17-27种。但对比《装备标准》,各级疾病预防控制机构实验室仪器设备配置仍有很大不足,以A类(完成常规工作所需仪器设备)设备为例,2002年省级配置率平均56.4%、市级36.1%和县级28.1%,2005年省市县配置率分别为63.6%、43.7%和38.6%。其中,省市县配置率低于30%的机构分别为7.1%、25.8%、33.9%。为了提高疾病预防控制机构的实验室检验能力,充分发挥公共职能,需要继续加强对设备的建设。
(二)经过三年的体系建设,各级疾病预防控制机构设备资产大幅增加,与国家装备标准相比,仍有较大缺口
设备资产能直接反映出疾病预防控制机构的设备配置规模,在三年体系建设过程中,全国疾病预防控制机构对实验室仪器设备建设加大投入,对常规设备和基本仪器设备进行配置和更新,省、市、县三级疾病预防控制机构的设备资产增加。2005年省市县三级疾病预防控制机构设备资产达到了3517.4万元、656.6万元、96.8万元,相对于2002年分别增长了71.5%、77.1%和61.9%。
如果按照国家装备标准为各级疾病预防控制机构配齐所对应的所有A类设备,2005年全国需要资金50.2亿,其中省级需要0.8亿,市级需要11.3亿,县级需要38.1亿元。设备资产量的增加有利于落实疾病预防控制机构实验室仪器设备配置的要求,便于开展实验室检验和履行疾病预防控制机构的公共职能。
(三)不同地区设备配置趋于均衡,但设备资产总额均衡性仍需值得关注
通过三年体系建设,省级疾病预防控制机构设备配置基尼系数值略有上升,市级变化不明显,县级机构设备配置基尼系数值下降,但2002年和2005年它们的值均小于0.3,说明整体上疾病预防控制机构,特别是市县级机构的设备种类在不同地区间趋于均衡。
从设备资产配置区域均衡看,2005年不同地区省级疾病预防控制机构的基尼系数为0.437,市级为0.538,县级为0.596,且省级机构变得更加不公平,虽然市级和县级机构的设备资产基尼系数分别下降了0.1和0.02,但仍然超过了0.4的警戒线,证实了设备建设均衡性仍旧是一个值得关注的问题,必须加强政府的调控。
从设备资产值来看,由于省级、市级和县级机构所在地区的不同,其仪器设备配置的资产总值在地区间并不均衡,结合仪器设备配置的种类在地区间趋于均衡,说明了同一级别的不同地区机构配置的仪器设备数量和质量是不均衡的。
(四)各级政府在疾病预防控制体系设备建设过程中投入增多,但自筹资金却占很大比例
为了有效开展检验工作、发挥公共卫生职能,实验室仪器设备等基础建设必须得到加强,基础建设需要政府重点投入。在疾病预防控制体系三年建设过程中,政府对设备的投入逐年增多,到2005年省、市、县级政府投入比例分别为45.7%、41.4%和33.0%,较2002年均有较大程度的提高。
随着社会需求的增加和疾病预防控制机构职能的变化,政府投入还远远不能满足疾病预防控制机构的设备建设的需要。为了能使各地疾病预防控制机构顺利开展工作,机构不得不通过自筹的办法进行筹措,致使各地疾病预防控制机构在设备建设过程中,单位自筹比例仍占很大比例,达到40.3%～73.4%,在一定程度上影响了这些机构自身的建设与发展。
(五)通过综合评价发现仍有半数省级疾病预防控制机构的实验室仪器设备配置不到位
设备资产值的增加可以给实验室仪器设备配置给予经费保证,设备配置的方向需要借助综合评价的程式得到。相对于2002年来说,除天津、山西等5省外,82.1%(23个省)的省级机构仪器设备综合评价得分有所增加,提示体系建设后,仪器设备配置总体得到了建设与发展。但是,在2005年,28个省级样本机构中,江苏、广东、山东、浙江等11个省级机构的综合评价得分大于3分(满分为5分),即仍有60.7%(17个省)连3分这一中等水平也没有达到。说明,即使在体系建设得到发展后的2005年,机构仪器设备配置的总体水平还是偏低的,距离配置标准和要求还有相当大的差距,也就是说其尚不能保证常规工作的开展。
(六)影响和制约实验室仪器设备配置种类数的因素较多
检验人员、人均实验室建筑面积、常住人口、单位职工年均工资、实际开展的检验项目数是影响机构实验室仪器设备配置的重要因素。各个因素对机构实验室仪器设备的影响程度说明:机构的实验室仪器设备配置量不只是受到当地经济水平的影响,更主要的受到机构的工作内容和工作量的影响,“机构检验人员数”和“人均实验室建筑面积”等因素在一定程度上从内部制约着实验室仪器设备的配置。
不管是省级、市级还是县级机构,发现检验人员、人均实验室建筑面积、常住人口、单位职工年均工资、实际开展的检验项目数等观察值呈现出与实验室仪器设备配置高低一致的规律,客观上证明了上述观点的科学性。
(七)检验设备投入的提高,极大地提升了疾病预防控制机构的检验能力
疾病预防控制机构实验室设备的投入增加,提高了检验能力。不同性质设备的投入会发展不同类型的检验能力。必需装备设备种类数的增加能提高疾病预防控制机构必须开展的工作项目数,拓展设备种类数的增加也相应地增加了根据地域特点和需求开展项目的能力,并且前者的影响程度要大于后者。
增加生物类设备种类数能提高疾病预防控制机构病原微生物的检测能力,同时,如果增加化学类设备种类数能提高疾病预防控制机构健康危害因素检测能力、放射卫生、职业卫生防护等方面的能力。从它们各自的影响程度和相关性可知,丰富化学类设备的种类能产生的效果更大。
四、研究中的主要探索和创新
1、研究方法的创新
在卫生系统宏观模型和政策制定科学化程序的指导下,综合运用纵向历史比较、地区间横向比较、规范差距分析等方法对机构实验室仪器设备配置现况和建设成效进行政策成效的系统评价,为疾病预防控制机构其他方面的系统评价提供综合应用方法学的借鉴;
通过Gini系数的运算评价实验室仪器设备配置的地区均衡性的变化,完成了方法学的应用创新;
将层次分析法、模糊综合评价法综合运用探索出评价机构的仪器设备配置的整体实力的综合方法。将方法学应用于省级机构配置情况,进行方法学检验和模拟,最后依据省级配置实际种类数和资产数对综合评价结果进行检验。
2、研究结果的创新
(1)综合运用纵向历史比较、地区间横向比较、规范差距分析等方法对机构实验室仪器设备配置现况和建设成效进行评价,发现体系建设前后,不同地区不同级别机构的设备种类都有所增加,以县级增长比例最大,达到了38.1%。但是比照国家《省、地、县级疾病预防控制机构实验室主要仪器装备标准》,各级机构设备配置仍存在很大不足,以A类(完成常规工作所需仪器设备)设备为例,2002年省级配置率平均56.4%、市级36.1%和县级28.1%,2005年省市县配置率分别为63.6%、43.7%和38.6%。其中,省市县配置率低于30%的机构分别为7.1%、25.8%、33.9%。说明,各级疾病预防控制机构设备配置数量有了很大改观,配置趋于完善,但机构设备配置率仍然较低,为了提高疾病预防控制机构的实验室检验能力,充分发挥公共职能,需要继续加强对各级疾病预防控制机构的实验室仪器设备的建设。
(2)借鉴Gini系数理论,评价不同级别疾控机构实验室仪器设备配置的地区均衡性变化。结果发现,体系建设三年来,28个省级机构、177个市级样本机构、566个县级样本机构设备配置种类的基尼系数值均小于0.3,说明不管省级、市级和县级机构所在地区如何,其仪器设备配置的种类在地区间趋于均衡。但是,从机构仪器设备资产总额来看,2005年省级机构设备资产总额基尼系数相对于2002年上升了0.054,市和县级分别下降了0.1和0.02,但均超过了0.4的警戒线,说明从设备资产值来看,由于省级、市级和县级机构所在地区的不同,其仪器设备配置的资产总值在地区间并不均衡,结合仪器设备配置的种类在地区间趋于均衡,说明了同一级别的不同地区机构的配置的仪器设备数量和质量是不均衡的。
(3)使用层次分析法确定不同类型设备在实验室检验过程中的影响权重,在此基础上运用模糊综合评价法,综合评价省级机构的仪器设备配置的整体实力,发现:相对于2002年来说,除天津、山西等5省外,82.1%(23个省)的省级机构仪器设备综合评价得分有所增加,提示体系建设后,仪器设备配置总体得到了建设与发展。但是,在2005年,28个省级样本机构中,江苏、广东、山东、浙江等11个省级机构的综合评价得分大于3分(满分为5分),即仍有60.7%(17个省)连3分这一中等水平也没有达到。说明,即使在体系建设得到发展后的2005年,机构仪器设备配置的总体水平还是偏低的,距离配置标准和要求还有相当大的差距,也就是说其尚不能保证常规工作的开展。
1.Study Objects and Significances
(1)To meet the need of disease prevention and control system reform and constructions
In 2003,the occurrence of the epidemic of atypical pneumonia revealed that Disease Prevention and Control System in China have many deep-seated problems. The Party Central Committee and the State Council explicitly brought forward the goals and tasks of strengthening public health system,and strived to build disease prevention and control system which covers urban and rural and whose function is perfect in three years.To achieve this goal,the state has adopted a series of important measures and taken a comprehensive and systematic construction work.
Construction of disease prevention and control system has been incorporated into national development planning,as one of the important tasks of building of a harmonious society.The system of disease prevention and control faces an unprecedented opportunity for development.
In the guidance of bond-financed projects,levels of nation devoted 11.6 billion to construct disease prevention and control center,improving the infrastructure and working conditions.National finance has also significantly increased the support of the special bund for prevention of major diseases.In the base of conclusion of many years of work,it launched 37 kinds of Direct Network reported test of infectious diseases and public health emergencies in a nationwide in 2004.The Systems construction and application made China's disease surveillance and management model undergo tremendous changes,which have greatly increased timeliness and accuracy of disease surveillance reports,and improved the epidemic analytical capacity and the capacity of detection of the early outbreak of infectious diseases. Through training of personnel and the corresponding measures are implemented,the ability and level of the disease prevention and control institutions has a further improvement.The environment of the whole society gives a very favorable condition for construction and development of disease prevention and control system,and the concept of all sectors of society participating in disease prevention and control work has more and more acceptance.
How to evaluate the progress of the three years construction of disease prevention and control system,the target's reach level of building the system,and analyze the problems and challenges in the process of building the system,is the need of scientific management and decision-making scientific,also the needs of consolidating the system building results and improving the construction of system.
Laboratory equipment directly reflects the level of technology of disease prevention and control system.To evaluate the whole regional disease prevention and control system must evaluate its laboratory equipment of the building.This paper is the evaluation of allocation of laboratory equipment,which is part of the whole study.
(2) Practical requirements of improvement of laboratory testing capacity of Disease prevention and control institutions
Detection and Evaluation of laboratory tests is the most important functions in Disease Control and Prevention institutions,including its specific tasks:to develop the biological,physical,chemical detection of risk factors related to diseases and health,isolate and identify pathogen of infectious diseases,laboratory diagnose of disease risk factors,analysis and identify of the incident poisoning Toxicology, evaluate of toxicology,provide of technical support to of treatment of public health emergencies,prevention and control of illness and health-related risk factors and health supervision and law enforcement.
Appropriate configuration of laboratory equipment plays an important role for the disease prevention and control institutions to achieve laboratory inspection and evaluation functions.
In July 2004,The Ministry of Health,National Development and Reform Commission issued(hereinafter referred to as "guidance"),clearly put forward the requirements of laboratory construction and requirements of equipment capacity and testing personnel,effectively promote the standardization of hardware and construction of laboratory building.In the "guidance", (hereinafter referred to as "equipment standard ") will clearly divide the equipment into three types:required for the completion of conventional(Category A),equipment in accordance with the basic functions(Category B) and equipment in accordance with local characteristics,the work demand(Category C).This meets the actual and future development needs. How does all levels of disease prevention and control institutions implement of "equipment standard",and how to evaluate becomes an important research background and content.Through the evaluation of the apparatus and equipment,it provides a scientific basis of decision-making and equipment planning for all levels of disease prevention and control institutions and health administrative departments.
(3)The needs of fill the blank of evaluation laboratory equipment of disease prevention and control institutions
The study of equipment configuration of disease control and prevention,even the large-scale,high precision equipment is little.Through keywords such as medical institutions,disease prevention and control institutions,sanitation and anti-epidemic stations,equipment,configuration,useness,comprehensive evaluation,I search the Chinese science and technology periodicals databases in 1999-2007,and found 3370 literatures related to the field of health,and 1715 literatures about the medical institutions,and only 45 literatures about disease prevention and related literature, only one document relevant to comprehensive evaluation.
Literature relevant to medical institutions mainly concentrated on the evaluation of fairness and efficiency of configuration of the major medical equipment,and studies of management of the scientific equipment,but always more evaluation of single or a certain type of equipment configuration,rarely comprehensive evaluation of agency units.
In the field of disease prevention and control,comprehensive evaluation for equipment of the agency units provides assessment methods for the future construction of disease prevention and control system.
The study aimed at evaluating construction of the laboratory equipment of the disease prevention and control system,probing into factors of laboratory equipment configuration of disease prevention and control system,in order to provide evidence-based basis to further improve inspection capacity of the disease prevention and control system.
2.Research methods and Data Sources
In this study,"A macro model of health system" and the "scientific policy-making procedures" as a guiding research methods,and "multiple qualitative and quantitative verification" method used to improve and demonstrate of methods and contents of disease prevention and control institutions laboratory equipment configuration.I study changes and states of laboratory equipment configuration through Longitudinal historical comparison,the regional horizontal comparison,a comparison with the standard method;AHP,fuzzy comprehensive evaluation are used to evaluate of the overall configuration situation of the agencies' laboratory equipment;explore affected factors to organize laboratory equipment distribution through econometric methods.
The main data collection methods include documents summarized methods,the basic institutions surveys.Provincial Census,municipal and county-level areas is systematic sampling.The actual questionnaire recovery of the sample region includes 771 disease prevention and control institutions,including 28 provincial institutions, municipal bodies 177,566 county agencies.
3.Main study results
(1) Equipment configuration number at all levels of disease prevention and control institutions has been greatly improved,and allocation tends to improve, but standard configuration rate of institutions equipment configuration is still low
Types of equipments of different areas in all levels of disease prevention and control institutions have increased a few;in particular the county level grew the largest proportion.After three years of construction,the number of equipment in every provincial disease prevention and control institutions configurations 69-104 species,the municipal has an average of 29-48 species,the county level 17-27 species. But contrast to the "equipment standard":the provincial disease prevention and control institutions main laboratory equipment needs 191 kinds,municipal 130, county-level 75 species,owing to historical debts it is still facing a serious shortage of equipment and obsolete equipment situation,and all levels of disease prevention and control institutions are still great lack of laboratory equipment configuration. Situations with low allocation rate are still more.Only Category A as an example,the rate of provincial allocation,municipal and counties less than 30 per cent of the bodies is 7.1%,25.8%,33.9%.In order to improve disease prevention and control institutions laboratory testing capacity,and give full play to public functions,the need to strengthen the building of the equipment continues.
On the Category A equipment(required for the completion of conventional),the western county level disease prevention and control institutions currently only equipped with 32.3%,there is a great gap between the requirements from the "equipment standard ",which is still no guarantee that their regular work launches. Tip that western county equipment is the next step of the key areas in the allocation.
In 2005,12 species(categories) of necessary equipment(category A and B) configuration rate of the provincial disease prevention and control institutions is below 20%,such as dispersion analyzer;24 species(categories)of municipal bodies was lower than the 20%,such as biological anatomy mirror,refract meters;18 of county agencies have less than 20%such as the formaldehyde analyzer equipment, sample pulverizes,which suggested that these devices are considered targets in the next round of construction equipment.
(2) After three years,equipment assets of all levels of the disease prevention and control institutions increased substantially
Equipment assets can be a direct reflection of equipment configuration size of the disease prevention and control institutions.In the construction of the system,the whole national disease prevention and control institutions increased investment in the construction of conventional equipment and basic equipment configuration and updating.Provincial,municipal,and county levels for disease prevention and control institutions equipment assets increased.The direction of government's equipment assets into disease prevention and control institutions is more reasonable.In the 2002 county has the biggest gap and at the three years construction,the county has the largest compensation.In 2005,provincial,municipal and counties disease control and prevention equipment assets reached 35.174 million Yuan,6.566 million Yuan and 968,000 Yuan,respectively,compared to 2002 increased by 71.5%,77.1%and 61.9%. The increase in assets of equipment can implement disease prevention and control institutions laboratory equipment configuration requirements,and facilitate the laboratory tests and public functions of.the disease prevention and control institutions
(3) Equipment of different regions increasingly balanced,but the balance of equipment assets still worthy of attention
Through three years of construction,the equipment distribution of the provincial disease prevention and control institutions more balanced,and county-level lower,the balance of the municipal better than the county level,but their values were less than 0.3,which means that through three years construction of the system,equipment of the overall disease prevention and control institutions in different types tends to balance among different regions.
Whether the asset allocation is fair or not directly related to fairness of equipment distribution of different geography.From asset regional allocation balance,the Gini coefficient of the provincial disease prevention and control institutions was 0.437,and 0.538 for the municipal and county to 0.596,but provincial agencies become more inequitable,while Gini coefficient of municipal and county agencies asset decreased by 0.1 and 0.02,but still exceeded the warning line of 0.4,it needs strengthening government control.It confirmed that it is still a matter of concern of the overall balance of the construction equipment.
(4) Governments input to equipment in the course of disease prevention and control system construction increased,but self-financing accounts for a large proportion
In order to effectively carry out the inspection work,play public health functions, laboratory equipment and other infrastructure must be strengthened.In the building process of disease prevention and control system,the investment of government to equipment increased year by year,and in 2005,the proportions of provincial,city, county institutions got input from government respectively reach 45.7%,41.4%and 33.0%,which is greater than the 2002.Municipal institutions got the largest increases. It means that government investment has target,which support for the weak institution-building.
With the increase in social demand and the change of disease prevention and control institutions functions,the Government investment can not meet the requirements of the construction equipment of the disease prevention and control institutions.In order to make disease prevention and control institutions work smoothly,agencies have had to be conducted through self-financing,which throughout in the course of construction equipment of the disease prevention and control institutions represents a significant proportion of shares from 40.3%to 73.4%, to a certain extent,it affected these institutions construction and development.
(5) Through fuzzy comprehensive evaluation we found that half of the provincial disease prevention and control institutions laboratory equipment configuration is not in place
Through method of fuzzy comprehensive evaluation and AHP,we get weight of laboratory equipment of the disease prevention and control institutions,and the allocation of various equipment configurations can be analyzed and compared.The increase in asset value can be configured to provide laboratory equipment funding guarantee.The direction of configuration needs comprehensive evaluation.With fuzzy comprehensive evaluation we get that comprehensive evaluation scores of Jiangsu,Guangdong,Shandong,Zhejiang,Guangxi,Hebei,Liaoning,Anhui,Fujian, Sichuan,Xinjiang 11 provinces(autonomous regions) than three,which is still 60.7% (17 provinces) less than three.Compared to 2002,except Tianjin,Shanxi,Liaoning, Zhejiang,Guizhou,five provinces(municipalities),82.1%(23 provinces) construction equipment developed.
(6) many factors affect and restrict the types of laboratory equipment configuration
Examiner,per capita area of the laboratory building,resident population,average workers annual wage,actual number of projects carried out affects laboratory equipment configuration.The tests need to carry out objectively require equipment in the laboratory,in turn,also restrict configuration types of the laboratory equipment. This factor of laboratory equipment configuration affects most notable.
Regardless of the provincial,municipal or county agencies,we found a rule that examiner,and per capita area of the laboratory building,resident population,workers average annual wage,actual number of projects carried out showed with the same level to laboratory equipment configuration.
(7) equipment investment increased greatly improve the disease prevention and control institutions inspection capacity
Disease prevention and control institutions laboratory equipment investment increases testing capacity.Different natures of the equipment will develop different types of testing capability.The number of necessary equipment increased enhances the number of projects of disease prevention and control institutions must be work of; the increased number of expanded equipment also increases the project demand for geographical characteristics and the ability to carry out.The degree of influence of the former is greater than the latter.
Increasing the number of biology types of equipment enhances pathogenic microorganism detection capability of disease prevention and control institutions,and if we increase the number of chemistry types of equipment,it can enhance health risk factors detection capabilities,radiological health,occupational health protection detection capacity.From their respective impact and relevance,we can see that if we rich variety of chemical categories of equipment,it can produce greater results.
4.Innovation and application
By fuzzy comprehensive evaluation and AHP,we can get integrated score as a agency unit of the laboratory equipment,combining the evaluation of the configuration of the types of equipment,the number of various of equipment,the impact weight of equipment in the process of laboratory testing.It provides a level of comprehensive evaluation methods for the field of public health equipment and other resources configuration.
By the use of econometrics I explore the impact factors of equipment construction, and the use of AHP and fuzzy comprehensive method to evaluate,the entire region is the unit of the disease prevention and control institutions,which includes CDC and the professional control stations.The aim is conducive to the implementation of the policy of regional health planning,and the principle of the rational allocation of resources.
(一)疾病预防控制体系建设进程的客观需要
2003年非典疫情的发生,暴露出我国疾病预防控制体系中存在的诸多深层次的问题,党中央、国务院明确提出了加强公共卫生体系建设的目标任务,力争用三年时间基本建成覆盖城乡、功能完善的疾病预防控制体系。为了实现此项目标,国家采取了一系列重大措施,开展了全面、系统的疾病预防控制体系建设工作。疾病预防控制体系建设已经纳入国家发展规划,成为构建和谐社会的重要任务之一。疾病预防控制事业面临着前所未有的发展机遇。
在国债项目的引导下,全国各级投入116个亿建设疾病预防控制中心,改善了基础设施和工作条件;国家财政也明显加大了对重大疾病预防专项经费的支持力度,加大人员培训和相应措施的落实力度,2004年起在全国范围内开展了37种传染病和突发公共卫生事件网络直报试运行。整个社会的大环境为疾病预防控制体系建设和发展提供了十分有利的条件,全社会都来参与疾病预防控制工作的观念为越来越多的人接受。
如何系统评价疾病预防控制体系三年建设进展,分析体系建设预期目标达成的程度,剖析体系建设过程中存在的问题与面临的挑战,是管理科学化和决策科学化的需要,也是巩固、发展体系建设成果和完善体系建设的需要。
本研究为“疾病预防控制体系建设系列评价研究”的分课题之一,在整个疾病预防控制体系建设研究中起着重要的作用。实验室仪器设备作为机构运行的硬件基础,保证机构能够开展传染病、地方病和寄生虫病的预防控制,防范生物化学恐怖,调查、控制、处理突发公共卫生事件以及为公共卫生监督提供技术支撑和服务,实验室仪器设备配置状况和水平直观上反映了疾病预防控制体系的建设成效,间接影响了疾病预防控制体系人力资源、公共卫生职能等相关部分的建设水平。对地区疾病预防控制体系建设的评价必须要评价其实验室仪器设备的建设情况。
(二)《省、地、县级疾病预防控制中心实验室建设指导意见》实施评价实验室检验检测与评价是疾病预防控制机构的重要职责,其具体任务包括:开展疾病和健康相关危害因素的生物、物理、化学因子检测,传染病病原学分离鉴定、疾病危害因素实验室诊断、中毒事件的毒物分析与鉴定和毒理学评价,为突发公共卫生事件的应急处置、疾病和健康相关危害因素的预防控制及卫生监督执法等提供技术支持。
适宜的实验室仪器设备配置对于疾病预防控制机构实现实验室检验检测与评价职能具有重要作用。
卫生部、国家发改委于2004年7月下发的《省、地、县级疾病预防控制中心实验室建设指导意见》(以下称《指导意见》),明确提出了实验室建设要求及其装备和检验人员能力要求,有力地推动了硬件建设和实验室规范化建设与发展。在《指导意见》中的《省、地、县级疾病预防控制机构实验室主要仪器装备标准》(以下简称《装备标准》)明确将仪器设备分成完成常规工作所需仪器设备(A类)、按照基本功能必须装备的基本仪器设备(B类)和根据地域特点、工作需求应装备的基本仪器设备三类(C类)。这结合了疾病预防控制机构的工作实际和未来发展需要。各级疾病预防控制机构对《装备标准》的实施情况如何,以及如何进行评价也成为本研究重要的研究背景和目的,通过对仪器装备的评价,评价政策实施成效,摸清薄弱环节,为各级疾病预防控制机构的装备规划和卫生行政部门决策提供科学依据。
(三)建立一套评价疾病预防控制机构实验室仪器设备配置的方法
仪器种类繁多,功能不一,如何对它的配置水平进行评价是卫生管理者和卫生决策者关心的问题。对大型医用设备配置评价可以从配置效率、配置公平、卫生技术评估等方面入手,但对疾病预防控制等公共卫生领域实验室设备评价的研究和实践不足。
本研究借鉴对大型医用设备配置公平性的评价方法,对实验室仪器设备配置的地区均衡性作了分析;运用层次分析法、模糊综合评价等方法,对省级机构实验室仪器设备建设程度进行了综合评价,并对评价结果的合理性进行初步验证,为市县疾病预防控制机构,也为公共卫生领域的仪器设备建设的综合评价方法提供了借鉴。
本次研究,旨在在评价疾病预防控制机构实验室仪器设备配置状况的基础上,探讨疾病预防控制机构实验室仪器设备配置的影响因素,为进一步提高疾病预防控制机构实验室设备建设,落实公共卫生能力提供循证依据。
二、材料与方法
本研究以“卫生系统宏观模型”和“政策制定科学程序”作为指导性研究方法,运用“定性定量多重论证”方法对疾病预防控制机构实验室仪器设备配置的方法和内容进行完善和论证,通过纵向历史比较、地区间横向比较、与标准比较等方法研究机构实验室仪器设备配置的变化情况和达标情况,运用层次分析法、模糊综合评价法对机构实验室仪器设备配置的总体情况进行评价;通过计量经济学等方法探索影响机构实验室仪器设备配置程度的因素。
主要的资料收集方法包括文献归纳法、机构基本情况调查等。省级地区普查,市级地区和县级地区系统抽样。采用“配对比较的样本含量计算公式”确定样本容最。省级调查表回收率为88%,市级调查表回收率为94%,县级调查表回收率为95%,分别回收了28、177、566份调查表。调查的主要内容有样本机构2002年和2005年登记在册的特定实验室仪器设备的实有数量、样本机构每年获得的设备投入、样本机构所在地区社会经济基本情况等信息。
三、主要研究结果
(一)各级疾病预防控制机构设备配置数量有了很大改观,配置趋于完善,但机构设备配置率仍然较低
三年体系建设后,不同地区各级疾病预防控制机构的设备种类数都有所增加,尤其县级的增长比例最大,为38.1%。就同一级别不同地区机构设备配置数量增幅而言,省级、市级最大在东部,县级最大在西部。就机构A、B、C三类仪器设备的配置率而言,省级机构主要是B类仪器设备的增加,增长率为8.4%,特别地,东部省级机构C类仪器设备的增幅是最大的(提高了12.8%):市县两级机构主要是A类仪器设备的增加,分别为提高了7.6%和10.5%。
经过三年体系建设,平均每省级疾病预防控制机构的设备配置数为69-104种,市级疾病预防控制机构平均为29-48种,县级疾病预防控制机构为17-27种。但对比《装备标准》,各级疾病预防控制机构实验室仪器设备配置仍有很大不足,以A类(完成常规工作所需仪器设备)设备为例,2002年省级配置率平均56.4%、市级36.1%和县级28.1%,2005年省市县配置率分别为63.6%、43.7%和38.6%。其中,省市县配置率低于30%的机构分别为7.1%、25.8%、33.9%。为了提高疾病预防控制机构的实验室检验能力,充分发挥公共职能,需要继续加强对设备的建设。
(二)经过三年的体系建设,各级疾病预防控制机构设备资产大幅增加,与国家装备标准相比,仍有较大缺口
设备资产能直接反映出疾病预防控制机构的设备配置规模,在三年体系建设过程中,全国疾病预防控制机构对实验室仪器设备建设加大投入,对常规设备和基本仪器设备进行配置和更新,省、市、县三级疾病预防控制机构的设备资产增加。2005年省市县三级疾病预防控制机构设备资产达到了3517.4万元、656.6万元、96.8万元,相对于2002年分别增长了71.5%、77.1%和61.9%。
如果按照国家装备标准为各级疾病预防控制机构配齐所对应的所有A类设备,2005年全国需要资金50.2亿,其中省级需要0.8亿,市级需要11.3亿,县级需要38.1亿元。设备资产量的增加有利于落实疾病预防控制机构实验室仪器设备配置的要求,便于开展实验室检验和履行疾病预防控制机构的公共职能。
(三)不同地区设备配置趋于均衡,但设备资产总额均衡性仍需值得关注
通过三年体系建设,省级疾病预防控制机构设备配置基尼系数值略有上升,市级变化不明显,县级机构设备配置基尼系数值下降,但2002年和2005年它们的值均小于0.3,说明整体上疾病预防控制机构,特别是市县级机构的设备种类在不同地区间趋于均衡。
从设备资产配置区域均衡看,2005年不同地区省级疾病预防控制机构的基尼系数为0.437,市级为0.538,县级为0.596,且省级机构变得更加不公平,虽然市级和县级机构的设备资产基尼系数分别下降了0.1和0.02,但仍然超过了0.4的警戒线,证实了设备建设均衡性仍旧是一个值得关注的问题,必须加强政府的调控。
从设备资产值来看,由于省级、市级和县级机构所在地区的不同,其仪器设备配置的资产总值在地区间并不均衡,结合仪器设备配置的种类在地区间趋于均衡,说明了同一级别的不同地区机构配置的仪器设备数量和质量是不均衡的。
(四)各级政府在疾病预防控制体系设备建设过程中投入增多,但自筹资金却占很大比例
为了有效开展检验工作、发挥公共卫生职能,实验室仪器设备等基础建设必须得到加强,基础建设需要政府重点投入。在疾病预防控制体系三年建设过程中,政府对设备的投入逐年增多,到2005年省、市、县级政府投入比例分别为45.7%、41.4%和33.0%,较2002年均有较大程度的提高。
随着社会需求的增加和疾病预防控制机构职能的变化,政府投入还远远不能满足疾病预防控制机构的设备建设的需要。为了能使各地疾病预防控制机构顺利开展工作,机构不得不通过自筹的办法进行筹措,致使各地疾病预防控制机构在设备建设过程中,单位自筹比例仍占很大比例,达到40.3%～73.4%,在一定程度上影响了这些机构自身的建设与发展。
(五)通过综合评价发现仍有半数省级疾病预防控制机构的实验室仪器设备配置不到位
设备资产值的增加可以给实验室仪器设备配置给予经费保证,设备配置的方向需要借助综合评价的程式得到。相对于2002年来说,除天津、山西等5省外,82.1%(23个省)的省级机构仪器设备综合评价得分有所增加,提示体系建设后,仪器设备配置总体得到了建设与发展。但是,在2005年,28个省级样本机构中,江苏、广东、山东、浙江等11个省级机构的综合评价得分大于3分(满分为5分),即仍有60.7%(17个省)连3分这一中等水平也没有达到。说明,即使在体系建设得到发展后的2005年,机构仪器设备配置的总体水平还是偏低的,距离配置标准和要求还有相当大的差距,也就是说其尚不能保证常规工作的开展。
(六)影响和制约实验室仪器设备配置种类数的因素较多
检验人员、人均实验室建筑面积、常住人口、单位职工年均工资、实际开展的检验项目数是影响机构实验室仪器设备配置的重要因素。各个因素对机构实验室仪器设备的影响程度说明:机构的实验室仪器设备配置量不只是受到当地经济水平的影响,更主要的受到机构的工作内容和工作量的影响,“机构检验人员数”和“人均实验室建筑面积”等因素在一定程度上从内部制约着实验室仪器设备的配置。
不管是省级、市级还是县级机构,发现检验人员、人均实验室建筑面积、常住人口、单位职工年均工资、实际开展的检验项目数等观察值呈现出与实验室仪器设备配置高低一致的规律,客观上证明了上述观点的科学性。
(七)检验设备投入的提高,极大地提升了疾病预防控制机构的检验能力
疾病预防控制机构实验室设备的投入增加,提高了检验能力。不同性质设备的投入会发展不同类型的检验能力。必需装备设备种类数的增加能提高疾病预防控制机构必须开展的工作项目数,拓展设备种类数的增加也相应地增加了根据地域特点和需求开展项目的能力,并且前者的影响程度要大于后者。
增加生物类设备种类数能提高疾病预防控制机构病原微生物的检测能力,同时,如果增加化学类设备种类数能提高疾病预防控制机构健康危害因素检测能力、放射卫生、职业卫生防护等方面的能力。从它们各自的影响程度和相关性可知,丰富化学类设备的种类能产生的效果更大。
四、研究中的主要探索和创新
1、研究方法的创新
在卫生系统宏观模型和政策制定科学化程序的指导下,综合运用纵向历史比较、地区间横向比较、规范差距分析等方法对机构实验室仪器设备配置现况和建设成效进行政策成效的系统评价,为疾病预防控制机构其他方面的系统评价提供综合应用方法学的借鉴;
通过Gini系数的运算评价实验室仪器设备配置的地区均衡性的变化,完成了方法学的应用创新;
将层次分析法、模糊综合评价法综合运用探索出评价机构的仪器设备配置的整体实力的综合方法。将方法学应用于省级机构配置情况,进行方法学检验和模拟,最后依据省级配置实际种类数和资产数对综合评价结果进行检验。
2、研究结果的创新
(1)综合运用纵向历史比较、地区间横向比较、规范差距分析等方法对机构实验室仪器设备配置现况和建设成效进行评价,发现体系建设前后,不同地区不同级别机构的设备种类都有所增加,以县级增长比例最大,达到了38.1%。但是比照国家《省、地、县级疾病预防控制机构实验室主要仪器装备标准》,各级机构设备配置仍存在很大不足,以A类(完成常规工作所需仪器设备)设备为例,2002年省级配置率平均56.4%、市级36.1%和县级28.1%,2005年省市县配置率分别为63.6%、43.7%和38.6%。其中,省市县配置率低于30%的机构分别为7.1%、25.8%、33.9%。说明,各级疾病预防控制机构设备配置数量有了很大改观,配置趋于完善,但机构设备配置率仍然较低,为了提高疾病预防控制机构的实验室检验能力,充分发挥公共职能,需要继续加强对各级疾病预防控制机构的实验室仪器设备的建设。
(2)借鉴Gini系数理论,评价不同级别疾控机构实验室仪器设备配置的地区均衡性变化。结果发现,体系建设三年来,28个省级机构、177个市级样本机构、566个县级样本机构设备配置种类的基尼系数值均小于0.3,说明不管省级、市级和县级机构所在地区如何,其仪器设备配置的种类在地区间趋于均衡。但是,从机构仪器设备资产总额来看,2005年省级机构设备资产总额基尼系数相对于2002年上升了0.054,市和县级分别下降了0.1和0.02,但均超过了0.4的警戒线,说明从设备资产值来看,由于省级、市级和县级机构所在地区的不同,其仪器设备配置的资产总值在地区间并不均衡,结合仪器设备配置的种类在地区间趋于均衡,说明了同一级别的不同地区机构的配置的仪器设备数量和质量是不均衡的。
(3)使用层次分析法确定不同类型设备在实验室检验过程中的影响权重,在此基础上运用模糊综合评价法,综合评价省级机构的仪器设备配置的整体实力,发现:相对于2002年来说,除天津、山西等5省外,82.1%(23个省)的省级机构仪器设备综合评价得分有所增加,提示体系建设后,仪器设备配置总体得到了建设与发展。但是,在2005年,28个省级样本机构中,江苏、广东、山东、浙江等11个省级机构的综合评价得分大于3分(满分为5分),即仍有60.7%(17个省)连3分这一中等水平也没有达到。说明,即使在体系建设得到发展后的2005年,机构仪器设备配置的总体水平还是偏低的,距离配置标准和要求还有相当大的差距,也就是说其尚不能保证常规工作的开展。
1.Study Objects and Significances
(1)To meet the need of disease prevention and control system reform and constructions
In 2003,the occurrence of the epidemic of atypical pneumonia revealed that Disease Prevention and Control System in China have many deep-seated problems. The Party Central Committee and the State Council explicitly brought forward the goals and tasks of strengthening public health system,and strived to build disease prevention and control system which covers urban and rural and whose function is perfect in three years.To achieve this goal,the state has adopted a series of important measures and taken a comprehensive and systematic construction work.
Construction of disease prevention and control system has been incorporated into national development planning,as one of the important tasks of building of a harmonious society.The system of disease prevention and control faces an unprecedented opportunity for development.
In the guidance of bond-financed projects,levels of nation devoted 11.6 billion to construct disease prevention and control center,improving the infrastructure and working conditions.National finance has also significantly increased the support of the special bund for prevention of major diseases.In the base of conclusion of many years of work,it launched 37 kinds of Direct Network reported test of infectious diseases and public health emergencies in a nationwide in 2004.The Systems construction and application made China's disease surveillance and management model undergo tremendous changes,which have greatly increased timeliness and accuracy of disease surveillance reports,and improved the epidemic analytical capacity and the capacity of detection of the early outbreak of infectious diseases. Through training of personnel and the corresponding measures are implemented,the ability and level of the disease prevention and control institutions has a further improvement.The environment of the whole society gives a very favorable condition for construction and development of disease prevention and control system,and the concept of all sectors of society participating in disease prevention and control work has more and more acceptance.
How to evaluate the progress of the three years construction of disease prevention and control system,the target's reach level of building the system,and analyze the problems and challenges in the process of building the system,is the need of scientific management and decision-making scientific,also the needs of consolidating the system building results and improving the construction of system.
Laboratory equipment directly reflects the level of technology of disease prevention and control system.To evaluate the whole regional disease prevention and control system must evaluate its laboratory equipment of the building.This paper is the evaluation of allocation of laboratory equipment,which is part of the whole study.
(2) Practical requirements of improvement of laboratory testing capacity of Disease prevention and control institutions
Detection and Evaluation of laboratory tests is the most important functions in Disease Control and Prevention institutions,including its specific tasks:to develop the biological,physical,chemical detection of risk factors related to diseases and health,isolate and identify pathogen of infectious diseases,laboratory diagnose of disease risk factors,analysis and identify of the incident poisoning Toxicology, evaluate of toxicology,provide of technical support to of treatment of public health emergencies,prevention and control of illness and health-related risk factors and health supervision and law enforcement.
Appropriate configuration of laboratory equipment plays an important role for the disease prevention and control institutions to achieve laboratory inspection and evaluation functions.
In July 2004,The Ministry of Health,National Development and Reform Commission issued
(3)The needs of fill the blank of evaluation laboratory equipment of disease prevention and control institutions
The study of equipment configuration of disease control and prevention,even the large-scale,high precision equipment is little.Through keywords such as medical institutions,disease prevention and control institutions,sanitation and anti-epidemic stations,equipment,configuration,useness,comprehensive evaluation,I search the Chinese science and technology periodicals databases in 1999-2007,and found 3370 literatures related to the field of health,and 1715 literatures about the medical institutions,and only 45 literatures about disease prevention and related literature, only one document relevant to comprehensive evaluation.
Literature relevant to medical institutions mainly concentrated on the evaluation of fairness and efficiency of configuration of the major medical equipment,and studies of management of the scientific equipment,but always more evaluation of single or a certain type of equipment configuration,rarely comprehensive evaluation of agency units.
In the field of disease prevention and control,comprehensive evaluation for equipment of the agency units provides assessment methods for the future construction of disease prevention and control system.
The study aimed at evaluating construction of the laboratory equipment of the disease prevention and control system,probing into factors of laboratory equipment configuration of disease prevention and control system,in order to provide evidence-based basis to further improve inspection capacity of the disease prevention and control system.
2.Research methods and Data Sources
In this study,"A macro model of health system" and the "scientific policy-making procedures" as a guiding research methods,and "multiple qualitative and quantitative verification" method used to improve and demonstrate of methods and contents of disease prevention and control institutions laboratory equipment configuration.I study changes and states of laboratory equipment configuration through Longitudinal historical comparison,the regional horizontal comparison,a comparison with the standard method;AHP,fuzzy comprehensive evaluation are used to evaluate of the overall configuration situation of the agencies' laboratory equipment;explore affected factors to organize laboratory equipment distribution through econometric methods.
The main data collection methods include documents summarized methods,the basic institutions surveys.Provincial Census,municipal and county-level areas is systematic sampling.The actual questionnaire recovery of the sample region includes 771 disease prevention and control institutions,including 28 provincial institutions, municipal bodies 177,566 county agencies.
3.Main study results
(1) Equipment configuration number at all levels of disease prevention and control institutions has been greatly improved,and allocation tends to improve, but standard configuration rate of institutions equipment configuration is still low
Types of equipments of different areas in all levels of disease prevention and control institutions have increased a few;in particular the county level grew the largest proportion.After three years of construction,the number of equipment in every provincial disease prevention and control institutions configurations 69-104 species,the municipal has an average of 29-48 species,the county level 17-27 species. But contrast to the "equipment standard":the provincial disease prevention and control institutions main laboratory equipment needs 191 kinds,municipal 130, county-level 75 species,owing to historical debts it is still facing a serious shortage of equipment and obsolete equipment situation,and all levels of disease prevention and control institutions are still great lack of laboratory equipment configuration. Situations with low allocation rate are still more.Only Category A as an example,the rate of provincial allocation,municipal and counties less than 30 per cent of the bodies is 7.1%,25.8%,33.9%.In order to improve disease prevention and control institutions laboratory testing capacity,and give full play to public functions,the need to strengthen the building of the equipment continues.
On the Category A equipment(required for the completion of conventional),the western county level disease prevention and control institutions currently only equipped with 32.3%,there is a great gap between the requirements from the "equipment standard ",which is still no guarantee that their regular work launches. Tip that western county equipment is the next step of the key areas in the allocation.
In 2005,12 species(categories) of necessary equipment(category A and B) configuration rate of the provincial disease prevention and control institutions is below 20%,such as dispersion analyzer;24 species(categories)of municipal bodies was lower than the 20%,such as biological anatomy mirror,refract meters;18 of county agencies have less than 20%such as the formaldehyde analyzer equipment, sample pulverizes,which suggested that these devices are considered targets in the next round of construction equipment.
(2) After three years,equipment assets of all levels of the disease prevention and control institutions increased substantially
Equipment assets can be a direct reflection of equipment configuration size of the disease prevention and control institutions.In the construction of the system,the whole national disease prevention and control institutions increased investment in the construction of conventional equipment and basic equipment configuration and updating.Provincial,municipal,and county levels for disease prevention and control institutions equipment assets increased.The direction of government's equipment assets into disease prevention and control institutions is more reasonable.In the 2002 county has the biggest gap and at the three years construction,the county has the largest compensation.In 2005,provincial,municipal and counties disease control and prevention equipment assets reached 35.174 million Yuan,6.566 million Yuan and 968,000 Yuan,respectively,compared to 2002 increased by 71.5%,77.1%and 61.9%. The increase in assets of equipment can implement disease prevention and control institutions laboratory equipment configuration requirements,and facilitate the laboratory tests and public functions of.the disease prevention and control institutions
(3) Equipment of different regions increasingly balanced,but the balance of equipment assets still worthy of attention
Through three years of construction,the equipment distribution of the provincial disease prevention and control institutions more balanced,and county-level lower,the balance of the municipal better than the county level,but their values were less than 0.3,which means that through three years construction of the system,equipment of the overall disease prevention and control institutions in different types tends to balance among different regions.
Whether the asset allocation is fair or not directly related to fairness of equipment distribution of different geography.From asset regional allocation balance,the Gini coefficient of the provincial disease prevention and control institutions was 0.437,and 0.538 for the municipal and county to 0.596,but provincial agencies become more inequitable,while Gini coefficient of municipal and county agencies asset decreased by 0.1 and 0.02,but still exceeded the warning line of 0.4,it needs strengthening government control.It confirmed that it is still a matter of concern of the overall balance of the construction equipment.
(4) Governments input to equipment in the course of disease prevention and control system construction increased,but self-financing accounts for a large proportion
In order to effectively carry out the inspection work,play public health functions, laboratory equipment and other infrastructure must be strengthened.In the building process of disease prevention and control system,the investment of government to equipment increased year by year,and in 2005,the proportions of provincial,city, county institutions got input from government respectively reach 45.7%,41.4%and 33.0%,which is greater than the 2002.Municipal institutions got the largest increases. It means that government investment has target,which support for the weak institution-building.
With the increase in social demand and the change of disease prevention and control institutions functions,the Government investment can not meet the requirements of the construction equipment of the disease prevention and control institutions.In order to make disease prevention and control institutions work smoothly,agencies have had to be conducted through self-financing,which throughout in the course of construction equipment of the disease prevention and control institutions represents a significant proportion of shares from 40.3%to 73.4%, to a certain extent,it affected these institutions construction and development.
(5) Through fuzzy comprehensive evaluation we found that half of the provincial disease prevention and control institutions laboratory equipment configuration is not in place
Through method of fuzzy comprehensive evaluation and AHP,we get weight of laboratory equipment of the disease prevention and control institutions,and the allocation of various equipment configurations can be analyzed and compared.The increase in asset value can be configured to provide laboratory equipment funding guarantee.The direction of configuration needs comprehensive evaluation.With fuzzy comprehensive evaluation we get that comprehensive evaluation scores of Jiangsu,Guangdong,Shandong,Zhejiang,Guangxi,Hebei,Liaoning,Anhui,Fujian, Sichuan,Xinjiang 11 provinces(autonomous regions) than three,which is still 60.7% (17 provinces) less than three.Compared to 2002,except Tianjin,Shanxi,Liaoning, Zhejiang,Guizhou,five provinces(municipalities),82.1%(23 provinces) construction equipment developed.
(6) many factors affect and restrict the types of laboratory equipment configuration
Examiner,per capita area of the laboratory building,resident population,average workers annual wage,actual number of projects carried out affects laboratory equipment configuration.The tests need to carry out objectively require equipment in the laboratory,in turn,also restrict configuration types of the laboratory equipment. This factor of laboratory equipment configuration affects most notable.
Regardless of the provincial,municipal or county agencies,we found a rule that examiner,and per capita area of the laboratory building,resident population,workers average annual wage,actual number of projects carried out showed with the same level to laboratory equipment configuration.
(7) equipment investment increased greatly improve the disease prevention and control institutions inspection capacity
Disease prevention and control institutions laboratory equipment investment increases testing capacity.Different natures of the equipment will develop different types of testing capability.The number of necessary equipment increased enhances the number of projects of disease prevention and control institutions must be work of; the increased number of expanded equipment also increases the project demand for geographical characteristics and the ability to carry out.The degree of influence of the former is greater than the latter.
Increasing the number of biology types of equipment enhances pathogenic microorganism detection capability of disease prevention and control institutions,and if we increase the number of chemistry types of equipment,it can enhance health risk factors detection capabilities,radiological health,occupational health protection detection capacity.From their respective impact and relevance,we can see that if we rich variety of chemical categories of equipment,it can produce greater results.
4.Innovation and application
By fuzzy comprehensive evaluation and AHP,we can get integrated score as a agency unit of the laboratory equipment,combining the evaluation of the configuration of the types of equipment,the number of various of equipment,the impact weight of equipment in the process of laboratory testing.It provides a level of comprehensive evaluation methods for the field of public health equipment and other resources configuration.
By the use of econometrics I explore the impact factors of equipment construction, and the use of AHP and fuzzy comprehensive method to evaluate,the entire region is the unit of the disease prevention and control institutions,which includes CDC and the professional control stations.The aim is conducive to the implementation of the policy of regional health planning,and the principle of the rational allocation of resources.
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