江苏省卫生资源公平性研究
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摘要
公平分配卫生资源是医疗体制改革的关键问题之一,2009年新医改中再次提出促进基本公共卫生服务逐步均等化,可见卫生公平的重要程度。本文通过分析江苏省卫生资源配置现状和居民健康情况,系统评价卫生资源配置公平性,探讨卫生人力、物力和财力资源配置在公平性方面存在的问题,为政府制定区域卫生规划,提高卫生资源配置公平性,促进江苏省卫生事业持续、协调、稳定、健康的发展提供依据。
文章采用统计描述方法对江苏省卫生资源现状进行分析;利用洛伦茨曲线和基尼系数对江苏省卫生人力、物力资源地理分布、人口分布公平性进行分析与评价;同时利用协整检验、修正误差模型对江苏省卫生财力资源公平性进行分析与评价。
研究发现,随着江苏省经济水平的发展,居民人均可支配收入明显增加,居民健康状况明显改善,2005年人口平均寿命75.32岁,高出全国平均水平1.32岁;2004～2008年江苏省卫生人力资源总量增加了5.23万人,医护人员的增长占到总增长的90%,但区域之间卫生资源配置差距显著,卫生人力资源配置公平性苏南好于苏北,基尼系数显示人口分布公平性好于地理分布公平性,其中护士地理分布的基尼系数(G=0.33574)已经接近相对不公平的警界值;2006～2008年江苏省卫生机构数、每千人拥有床位数、综合医院医生人均每目担负的诊疗人次和住院人次以及实际病床使用率都呈上升趋势,其中卫生机构床位数的人口分布基尼系数(G=0.1907)和地理分布基尼系数(G=0.2875)均较小,表明公平性较好;江苏省卫生事业费总量以及人均卫生事业费逐年上升,但卫生事业费占财政支出比例逐年下降,到2006年已经开始低于全国平均水平,只占到财政总支出的1.8%,卫生事业费相对于GDP增长的长期弹性系数为0.8436,表明江苏省卫生事业费增长低于经济发展水平,政府投入严重不足;各级医院人均医疗费用连年上升。
政府应从以下几方面改善卫生公平。第一调整卫生人力内部结构,形成合理医护比例,提高卫生人力资源地理公平性;第二充分发挥基层医疗服务机构作用,加强区域医疗机构的交流与合作,实现卫生物力资源共享,提高现有卫生资源利用效率;第三强调政府责任,增加公共卫生支出,形成卫生事业与经济同步健康发展的局面;第四实行切实有效的方法进一步降低医疗费用,加强对贫困地区以及低收入人群的医疗补助力度,降低药费比例。
Equitable distribution of health resources is one of the key issues of medical system reform. Medical reform in 2009 emphasized the importance of the equalization of basic public health services again. This study describes the status of health resource allocation and health care status of the inhabitants, assesses the equality of health resource allocation, and analyzes problems existing in resource allocation. The purpose is to provide references to enact regional health planning, to optimize the allocation of health resource and promote the development abidingly, concordantly, stably and healthily in Jiangsu Province.
This study chooses Jiangsu Province as the object of the research. Lorenz Curve and Gini Coefficient are used in the equality of human and material resources analysis. The Cointegration Test and error-correction model are used in the equality of financial resources for health.
With the development of economy, disposable personal income has significantly increased. Health care status of the inhabitants has significantly improved. Average life expectancy is 75.32 years old, higher 1.32 than the national average. The total human resource for health has increased by 52.3 thousand persons from 2004 to 2008. The growth of medical care personnel accounting for overall growth was 90 percent. However, the gap between regions is obvious extremely in the allocation of health resources. Fairness of health human resources in the south of Jiangsu is better than the north of Jiangsu. Gini Coefficient shows the equity of population distribution is better than geographic distribution. Gini Coefficient (G=0.33574) of nurses of geographic distribution is closed to inequity. From 2006 to 2008, number of health institutions and beds per thousand people showed escalating trend; the number of doctors per capita daily outpatients was going up; rate of utilization of hospital beds also rised. The Gini coefficients of population and geographic distribution were both lesser, which showed equity better. The total health expenditure and per capita health expenditure increased year by year, the end of 2008, and reached respectively 5.354 billion yuan and 70.92 yuan, but the total investment proportion of financial expenditure decreased year by year. The proportion investment has been lower than that of the national average, accounting for 1.8 percent, Since 2006. Expenditure on health care relative to GDP growth was 0.8436 in the long-term elasticity coefficient. The growth of expenditure on health care was lower than the level of economic development; The per capita medical costs increase year by year.
Firstly, the government should adjust the internal structure of the health workforce to form a reasonable rate between doctors and nurses and improve the geographical equity in health in health human resources. Secondly, give full play to the role of primary care services, strengthen regional exchanges and cooperation between medical institution. the purpose of sharing material resource to health is to improve the efficiency of existing health resources. Thirdly, the government should increase public health spending and health protection goes hand in hand with economic development. Fourthly, the government implements practical and effective method to further reduce health care costs and expenses for medicine and increases the amount of compensation for poor areas and low-income populations.
文章采用统计描述方法对江苏省卫生资源现状进行分析;利用洛伦茨曲线和基尼系数对江苏省卫生人力、物力资源地理分布、人口分布公平性进行分析与评价;同时利用协整检验、修正误差模型对江苏省卫生财力资源公平性进行分析与评价。
研究发现,随着江苏省经济水平的发展,居民人均可支配收入明显增加,居民健康状况明显改善,2005年人口平均寿命75.32岁,高出全国平均水平1.32岁;2004～2008年江苏省卫生人力资源总量增加了5.23万人,医护人员的增长占到总增长的90%,但区域之间卫生资源配置差距显著,卫生人力资源配置公平性苏南好于苏北,基尼系数显示人口分布公平性好于地理分布公平性,其中护士地理分布的基尼系数(G=0.33574)已经接近相对不公平的警界值;2006～2008年江苏省卫生机构数、每千人拥有床位数、综合医院医生人均每目担负的诊疗人次和住院人次以及实际病床使用率都呈上升趋势,其中卫生机构床位数的人口分布基尼系数(G=0.1907)和地理分布基尼系数(G=0.2875)均较小,表明公平性较好;江苏省卫生事业费总量以及人均卫生事业费逐年上升,但卫生事业费占财政支出比例逐年下降,到2006年已经开始低于全国平均水平,只占到财政总支出的1.8%,卫生事业费相对于GDP增长的长期弹性系数为0.8436,表明江苏省卫生事业费增长低于经济发展水平,政府投入严重不足;各级医院人均医疗费用连年上升。
政府应从以下几方面改善卫生公平。第一调整卫生人力内部结构,形成合理医护比例,提高卫生人力资源地理公平性;第二充分发挥基层医疗服务机构作用,加强区域医疗机构的交流与合作,实现卫生物力资源共享,提高现有卫生资源利用效率;第三强调政府责任,增加公共卫生支出,形成卫生事业与经济同步健康发展的局面;第四实行切实有效的方法进一步降低医疗费用,加强对贫困地区以及低收入人群的医疗补助力度,降低药费比例。
Equitable distribution of health resources is one of the key issues of medical system reform. Medical reform in 2009 emphasized the importance of the equalization of basic public health services again. This study describes the status of health resource allocation and health care status of the inhabitants, assesses the equality of health resource allocation, and analyzes problems existing in resource allocation. The purpose is to provide references to enact regional health planning, to optimize the allocation of health resource and promote the development abidingly, concordantly, stably and healthily in Jiangsu Province.
This study chooses Jiangsu Province as the object of the research. Lorenz Curve and Gini Coefficient are used in the equality of human and material resources analysis. The Cointegration Test and error-correction model are used in the equality of financial resources for health.
With the development of economy, disposable personal income has significantly increased. Health care status of the inhabitants has significantly improved. Average life expectancy is 75.32 years old, higher 1.32 than the national average. The total human resource for health has increased by 52.3 thousand persons from 2004 to 2008. The growth of medical care personnel accounting for overall growth was 90 percent. However, the gap between regions is obvious extremely in the allocation of health resources. Fairness of health human resources in the south of Jiangsu is better than the north of Jiangsu. Gini Coefficient shows the equity of population distribution is better than geographic distribution. Gini Coefficient (G=0.33574) of nurses of geographic distribution is closed to inequity. From 2006 to 2008, number of health institutions and beds per thousand people showed escalating trend; the number of doctors per capita daily outpatients was going up; rate of utilization of hospital beds also rised. The Gini coefficients of population and geographic distribution were both lesser, which showed equity better. The total health expenditure and per capita health expenditure increased year by year, the end of 2008, and reached respectively 5.354 billion yuan and 70.92 yuan, but the total investment proportion of financial expenditure decreased year by year. The proportion investment has been lower than that of the national average, accounting for 1.8 percent, Since 2006. Expenditure on health care relative to GDP growth was 0.8436 in the long-term elasticity coefficient. The growth of expenditure on health care was lower than the level of economic development; The per capita medical costs increase year by year.
Firstly, the government should adjust the internal structure of the health workforce to form a reasonable rate between doctors and nurses and improve the geographical equity in health in health human resources. Secondly, give full play to the role of primary care services, strengthen regional exchanges and cooperation between medical institution. the purpose of sharing material resource to health is to improve the efficiency of existing health resources. Thirdly, the government should increase public health spending and health protection goes hand in hand with economic development. Fourthly, the government implements practical and effective method to further reduce health care costs and expenses for medicine and increases the amount of compensation for poor areas and low-income populations.
引文
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