“十三五”初期海南省医疗卫生资源配置公平性分析
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摘要
目的:分析"十三五"初期海南省卫生资源配置的公平性,为进一步优化配置卫生资源提供参考依据。方法:对卫生机构数指标进行修正,采用描述性分析、基尼系数和泰尔指数,从人口、地理两个维度对2016年海南省18个市县医疗卫生资源配置的公平性进行评价。结果:2016年海南省的卫生资源配置水平总体落后于全国平均水平,卫生资源集中于经济发达地区。卫生资源配置按人口和地理分布的基尼系数分别为0.107～0.296和0.301～0.531。政府支出的组间不均衡较为明显,卫生人员和床位组内不公平更明显,北部地区对总泰尔指数贡献率最大。结论:"十三五"初期海南省卫生资源配置的公平性存在区域不均衡现象,人口分布的公平性优于地理分布。北部地区不均衡性最为严重,医疗卫生资源虹吸效应明显,需要进一步调控区域内外部医疗卫生资源投入,改善人口密集地区、偏远地区和基层卫生资源配置。
Objective: To provide the basis for optimizing health resources allocation by analyzing the status and equity of Hainan's health resource allocation in the early 13 th five-year plan period. Methods: The index of health institutions was revised. Descriptive analysis, Gini coefficient and Theil Index were applied to analyze and evaluate the status and equity of health resource allocation in 18 cities and counties of Hainan Province in 2016 from the perspective of population and geography distribution. Results: In 2016, the level of health resource allocation in Hainan Province generally lagged behind the national average, and health resources were concentrated in developed areas. The Gini coefficients of health resources according to the population and geography were 0.107～0.296 and 0.301～0.531. The imbalance between groups of government expenditures was more obvious, while the inequity within the group of health personnel and bed was greater. The northern region had the largest contribution rate to the total Thiel index. Conclusion: The health resource allocation was unbalanced among regions in Hainan Province in the early 13 th Five-Year Plan period. The equity of population was better than the geography distribution. The imbalance in the northern region was the most serious with distinct siphon effect of health resources. It is suggested to adjust the investment of health resources within and among the regions and improve the allocation of health resources in densely populated areas, remote areas and grassroots areas.
Objective: To provide the basis for optimizing health resources allocation by analyzing the status and equity of Hainan's health resource allocation in the early 13 th five-year plan period. Methods: The index of health institutions was revised. Descriptive analysis, Gini coefficient and Theil Index were applied to analyze and evaluate the status and equity of health resource allocation in 18 cities and counties of Hainan Province in 2016 from the perspective of population and geography distribution. Results: In 2016, the level of health resource allocation in Hainan Province generally lagged behind the national average, and health resources were concentrated in developed areas. The Gini coefficients of health resources according to the population and geography were 0.107～0.296 and 0.301～0.531. The imbalance between groups of government expenditures was more obvious, while the inequity within the group of health personnel and bed was greater. The northern region had the largest contribution rate to the total Thiel index. Conclusion: The health resource allocation was unbalanced among regions in Hainan Province in the early 13 th Five-Year Plan period. The equity of population was better than the geography distribution. The imbalance in the northern region was the most serious with distinct siphon effect of health resources. It is suggested to adjust the investment of health resources within and among the regions and improve the allocation of health resources in densely populated areas, remote areas and grassroots areas.
引文
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[15]LIU J X,GORYAKIN Y,MAEKA A,et al.Global health workforce labor market projections for 2030[J].Human resource for health,2017(15):11-23.
[2]海南统计局.海南统计年鉴2017[M].北京:中国统计出版社,2017.
[3]刘文彬,李跃平,卢若艳,等.2005-2014年福建省卫生资源配置状况与公平性研究[J].中国卫生经济,2016,35(4):57-60.
[4]郝义彬,裴青燕,鲁锋,等.“十二五”末期我国医疗卫生资源配置的公平性及效率研究[J].中国卫生资源,2017,20(6):11-15.
[5]柴源,张玉琼,张列强,等.2010-2015年贵州省卫生资源配置公平性趋势分析[J].现代预防医学,2017,44(17):50-53.
[6]戴璟,李小涵,张春艳,等.云南省卫生资源公平性分析[J].中国卫生资源,2017,20(2):110-113.
[7]黄转苦,冯忠明,张诚一.海南省卫生资源配置公平性泰尔指数评价[J].中国公共卫生,2016,32(4):527-530.
[8]温俊娜,杨永宏,姜艳,等.基于基尼系数和差别指数的宁夏地区卫生资源配置公平性分析[J].中国卫生经济,2016,35(4):61-64.
[9]郭玉秀,宋国强,周荣耀,等.安徽省卫生资源配置现状及公平性研究[J].中国卫生资源,2018,21(4):318-322.
[10]PRICE M.The consequences of health service privatisation for equality and equity in health care in South Africa[J].Social Science&Medicine,1988,27(7):703-716.
[11]舍曼·富兰德.卫生经济学[M].北京:中国人民大学出版社,2011.
[12]吴欣,许仁丹,叶清丽.我国社区中医财政投入的公平性分析:基于基尼系数和泰尔指数视角[J].中国卫生经济,2014,33(6):55-58.
[13]符王润.我省推进“东西南北中”五大区域医疗中心建设[N].海口日报.2017-04-20(2).
[14]王帅,戴明峰,蔡敏,等.我国基层卫生人力资源配置公平性研究[J].中国卫生信息管理杂志,2017,14(4):577-583.
[15]LIU J X,GORYAKIN Y,MAEKA A,et al.Global health workforce labor market projections for 2030[J].Human resource for health,2017(15):11-23.