新医改以来我国基本医疗服务均等化分析
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摘要
目的分析我国2010—2016年基层医疗卫生资源配置现状和均等化水平,为制定优化基层卫生资源配置的政策提供科学依据。方法运用泰尔指数分析我国2010—2016年基层卫生资源配置的均等化水平。结果 2010—2016年我国基层卫生资源总量增加,差异性逐渐缩小,区域内差异是导致不均等性的主要原因。东部和东北部的基层卫生资源配置泰尔指数均为负值,基层卫生资源占比低于人口占比;基层人员的配置均衡性优于基层机构和床位配置;东部基层卫生服务诊疗人次增长速度最快,其次是中部、东北部和西部。结论中央政府应通过转移支付功能加大对经济落后地区的卫生投入;加快区域卫生资源共享力度,引导优质卫生资源向基层下沉;制定科学合理的服务价格体系,建立以政府为主导的多元化供给机制,提升基层卫生服务的活力和服务水平。
OBJECTIVE To analyze the status and equity of grassroots health resources allocation in China from 2010 to 2016,to provide scientific basis for optimizing primary health resources allocation. METHODS Theil index was used to analyze the equity of primary health resources allocation in China from 2010 to 2016. RESULTS From 2010 to 2016,the quantity of primary health resource allocation had been increased,while the inequity has been broaden which was mainly due to differences in regional internal. The Theil index was negative value in both east region and northeast region,showing proportion of grassroots health resources was lower than that of the population in these two areas. The equity of the primary staff was configuration superior to that of the primary organizations and bed configuration. East region had the fastest growth rate in primary health service visits,followed by the central,northeast and the west. CONCLUSION The central government should increase the health investment in economic backward areas through the transfer payment function. Regional health resources sharing needed to be accelerated and the high quality health resources should be guided to the primary level increasingly.Scientific and reasonable service price system should be made and a diversified supply mechanism led by the government should be established to improve the vitality and service level of primary health services.
OBJECTIVE To analyze the status and equity of grassroots health resources allocation in China from 2010 to 2016,to provide scientific basis for optimizing primary health resources allocation. METHODS Theil index was used to analyze the equity of primary health resources allocation in China from 2010 to 2016. RESULTS From 2010 to 2016,the quantity of primary health resource allocation had been increased,while the inequity has been broaden which was mainly due to differences in regional internal. The Theil index was negative value in both east region and northeast region,showing proportion of grassroots health resources was lower than that of the population in these two areas. The equity of the primary staff was configuration superior to that of the primary organizations and bed configuration. East region had the fastest growth rate in primary health service visits,followed by the central,northeast and the west. CONCLUSION The central government should increase the health investment in economic backward areas through the transfer payment function. Regional health resources sharing needed to be accelerated and the high quality health resources should be guided to the primary level increasingly.Scientific and reasonable service price system should be made and a diversified supply mechanism led by the government should be established to improve the vitality and service level of primary health services.
引文
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[2]原国家卫生部,财政部,国家人口和计划生育委员会.关于促进基本公共卫生服务逐步均等化的意见[J].中国社区医学,2009(3):38-40.
[3]王上铭.基于泰尔指数的我国地区卫生资源分布公平度研究[J].中国卫生经济,2014,33(3):71-73.
[4]康海媛,孙焱林.我国各省区医疗卫生资源配置水平的比较研究[J].中国卫生经济,2013,33(11):41-43.
[5]张楠,孙晓杰,李成,等.基于泰尔指数的我国卫生资源配置公平性分析[J].中国卫生事业管理,2014,32(2):88-91.
[6]甘行琼,赵继莹,甘娜.我国城乡基本医疗卫生服务均等化的实证研究--以东中西三省区为例[J].财政监督,2014(1):64-69.
[7]高萍.区域基本医疗卫生服务均等化现状、成因及对策--基于全国各省面板数据的分析[J].宏观经济研究,2015(4):90-97.
[8]李晓燕.区域基本卫生服务均等化影响因素分析[J].华南农业大学学报(社会科学版),2012,11(3):103-111.
[9]杨宜勇,刘永涛.我国省际公共卫生和基本医疗服务均等化问题研究[J].经济与管理研究,2008(5):11-17.
[10]国家统计局.东西中部和东北地区划分方法[EB/OL].(2011-10-5)[2016-9-8].http://www.stats.gov.cn/ztjc/zthd/sjtjr/dejtjkfr/tjkp/201106/t20110613_71947.htm.
[11]DE LA VEGA C L,VOLIJ O.A simple proof of Foster’s(1983)characterization of the Theil measure of inequality[J].Economic modelling,2013(35):940-943.
[12]张璐琴.医改以来我国医疗卫生资源配置变迁及思考[EB/OL].(2012-5-25)[2016-10-3].http://www.china-reform.org/content_363.html.