北京市医疗资源配置与人口发展关系研究
|
摘要
本文以北京市为研究对象,通过对北京市医疗资源配置现状的分析,以人口因素作为对医疗资源的关键影响因素进行分析,分别从人口的数量、密度、分布及人口年龄结构变化等角度出发,从医疗资源的需求与供给两个方面考察了医疗资源配置的公平性、合理性,为北京市政府进一步制定医疗卫生事业改革与发展规划,优化医疗资源配置提供信息和政策性依据。
本文收集北京市历年医疗机构、各级医院数、病床数、医护人员等数据;收集全市各地区人口资料。采用动态数列极其分析指标用以描述、分析北京市医疗资源配置情况及其发展趋势。借助洛伦茨曲线(Lorenz curve)和基尼系数(Gini coeffient)方法,测量北京市2005年医疗机构、二级以上医院、医护人员、病床数的人口、老龄人口及地理分布的基尼系数,以评价医疗资源配置的公平性。
研究结果表明,随着经济发展、人口城市化和老年化、疾病模式的转变,北京市居民医疗需要量将逐步提高。北京市各区县医疗资源供给不均衡,郊区与城区相差较大。通过基尼系数分析,医疗资源人口分布公平性优于地理分布公平性。医疗资源人口分布公平性和老年人口分布公平性的基尼系数都在0.3以下,为相对公平;而地理分布公平性大于0.4,为不公平状态。因此,要发展北京市的医疗卫生事业,必须强化区域规划,调整资源结构,提高资源绩效。
This study takes Beijing as a research project, analyzed the health resources allocationiin Peking,and analyzed population factor as a key impact factor to the health resources allocation from the amount,density of population ,distribute and age structure variety etc.Meanwhile the relationship between its supply and demand was also expunded to analyze the equity and efficiency and some problems of the health resources of Beijing .The study provided lots of valuable information and the policy options for policy makers to make and deepen health sector reform of Beijing ,and to implement regional health planning and to optimize the health resources allocation for the government.
This study collected the date through the years health organization, all levels hospital number, sickbed number, medical personnel etc. ,and collected the whole city area population data in everyplace.Adopt the dynamic series and its indexes in order to analysis health resources allocation in Beijing and its development trend.The Gini coefficients of population and geographic distribution on health-skilled personnel (certified physicians and registered nurses) , sickbed numbers and secondary hospital in Beijing were determined in 2005 applying Lorenz curve and Gini coefficient method to evaluate the distribution equity of health resources in population ,advanced age population and geographic areas.
The Beijing health resource allocation structure investigating result show:Due to economic development,population urbanization and aging and change in illness pattern,people in Peking will require more medical care.The distribution is unbalanced as there is quite a difference between urban and suburb.The population distribution in medical resource is better than that in geography.In view of the population distribution and aging population distribution of health resources,the Gini coefficients were both below 0.3,which were in the range of relaive equity.Considering on the geographic distribution of health resources ,the coefficients were above 0.4,which were in the range of unfairmess.So to develop health sector in Beijing,it is necessary to enhance a district programming, adjust resources structure, raise resources results.
本文收集北京市历年医疗机构、各级医院数、病床数、医护人员等数据;收集全市各地区人口资料。采用动态数列极其分析指标用以描述、分析北京市医疗资源配置情况及其发展趋势。借助洛伦茨曲线(Lorenz curve)和基尼系数(Gini coeffient)方法,测量北京市2005年医疗机构、二级以上医院、医护人员、病床数的人口、老龄人口及地理分布的基尼系数,以评价医疗资源配置的公平性。
研究结果表明,随着经济发展、人口城市化和老年化、疾病模式的转变,北京市居民医疗需要量将逐步提高。北京市各区县医疗资源供给不均衡,郊区与城区相差较大。通过基尼系数分析,医疗资源人口分布公平性优于地理分布公平性。医疗资源人口分布公平性和老年人口分布公平性的基尼系数都在0.3以下,为相对公平;而地理分布公平性大于0.4,为不公平状态。因此,要发展北京市的医疗卫生事业,必须强化区域规划,调整资源结构,提高资源绩效。
This study takes Beijing as a research project, analyzed the health resources allocationiin Peking,and analyzed population factor as a key impact factor to the health resources allocation from the amount,density of population ,distribute and age structure variety etc.Meanwhile the relationship between its supply and demand was also expunded to analyze the equity and efficiency and some problems of the health resources of Beijing .The study provided lots of valuable information and the policy options for policy makers to make and deepen health sector reform of Beijing ,and to implement regional health planning and to optimize the health resources allocation for the government.
This study collected the date through the years health organization, all levels hospital number, sickbed number, medical personnel etc. ,and collected the whole city area population data in everyplace.Adopt the dynamic series and its indexes in order to analysis health resources allocation in Beijing and its development trend.The Gini coefficients of population and geographic distribution on health-skilled personnel (certified physicians and registered nurses) , sickbed numbers and secondary hospital in Beijing were determined in 2005 applying Lorenz curve and Gini coefficient method to evaluate the distribution equity of health resources in population ,advanced age population and geographic areas.
The Beijing health resource allocation structure investigating result show:Due to economic development,population urbanization and aging and change in illness pattern,people in Peking will require more medical care.The distribution is unbalanced as there is quite a difference between urban and suburb.The population distribution in medical resource is better than that in geography.In view of the population distribution and aging population distribution of health resources,the Gini coefficients were both below 0.3,which were in the range of relaive equity.Considering on the geographic distribution of health resources ,the coefficients were above 0.4,which were in the range of unfairmess.So to develop health sector in Beijing,it is necessary to enhance a district programming, adjust resources structure, raise resources results.
引文
[1]国家信息中心中国经济信息网.CEI中国行业发展报告(2004)——医疗服务业[M].中国经济出版社,2005年3月.
[2]姜向群:《老年社会保障制度—历史与变革》,中国人民大学出版社出版,2005,第228页。
[3]《国外老龄问题》,甘肃人民出版社,1987。
[4]张力平:《生物心理社会医学模式的老人健康状况研究方法》,《中国社会医学》,1985年第1期。
[6]卫生技术人员是指卫生机构中医生、护理人员、药剂人员、检验人员等卫生技术人员。
[1]北京市统计局.北京市2006年国民经济和社会发展统计公报[M].中国统计出版社,2007年1月.
[2]青岛市卫生局.采用调整卫生机构去优化卫生资源配置[J].中华医院管理杂志.1999,15:202-204.
[3]封润华.近年来北京各区县人口地域分布变化的研究[J].人口与经济.2006,4:39-42.
[4]张倩.我国人口老龄化与政府在老龄产品和服务提供中的角色.北京大学在职攻读专业硕士学位论文.2007年3月,31-33.
[5]杜鹏.人口老龄化与老龄问题[M].中国人口出版社,2006年2月第1版.
[6]杨彦.北京市老年人力资源开发研究.首都经济贸易大学硕士学位论文,2004年3月,6-10.
[7]张纯,曹广忠.北京市人口老龄化的空间特征及影响因素[J].城市人口.2007,2:56-61.
[8]田雪原,沙吉才,杨子慧.中国老年人口(人口)[M].社会科学文献出版社.2007年4月第2版.
[9]汤哲,孟琛.北京市人口老龄化的发展趋势及其老年卫生保健工作现状[J].老年医学与保健.2000,3:149-150.
[10]郭子恒.医院管理学[M].人民卫生出版社.1983年8月第1版.
[11]李笃志.我国医院的发展模式研究.对外经济贸易大学硕士学位论文,2004年10月,1-3.
[12]高明.福建省卫生资源优化配置研究.福建师范大学硕士毕业论文,2006年9月,25-30.
[13]李倩.湖北省卫生资源配置的效率和公平性研究.博士毕业论文.2004年3月,52-57.
[14]黄荣清.1980年代以来北京市城市化过程中人口分布的变化[J].人口研究.2005,(5):19-26.
[15]刘莉.衡阳市城市医疗资源配置与运行状况的调查研究.中南大学硕士学位论文.2007年5月,7-10.
[16]冯建武.2004年温州市医疗资源配置分析.华东师范大学硕士学位论文.2006年9月,36-40.
[17]王雯菲,张文新.改革开放以来北京市人口分布及其演变[J].人口研究.2001,25(1):62-66.
[18]张文新.北京市人口分布与服务设施分布的协调性分析[J].北京社会科学.2004,(1):78-84.
[19]卢明名.我国人口老龄化对经济发展的影响研究.东北师范大学硕士学位论文.2007年5月,2-4.
[20]汤哲,方向华,项曼君,吴晓光,刁丽君,刘宏军.北京市老年人卫生服务需求研究[J].中华医院管理杂志.2004,20(8):464-469.
[21]张强,张琼,李宁秀.成都市城市社区老年人健康相关认知及行为研究[J].四川大学学报(医学版).2007,38(3):480-483.
[22]王德文,林维文,周天枢.福州市老年人慢性病现状调查.中国公共卫生.2004,20(10):1242-1243.
[23]胡至毅,张兆干.城市饭店的空间布局分析——以南京市为例.经济地理.2002,22(1):106-110.
[24]张文忠.经济区位论[M].北京出版社.2000,150-200.
[25]冯建,周一星.1990年代北京市人口空间分布的最新变化[J].城市规划.2003,27(5):55-62.
[26]冯建,周一星.杭州市人口的空间变动与郊区化研究[J].城市规划.2002,26(1):58-65.
[27]刘雪.人口老龄化背景下城镇老年人医疗需求研究.吉林大学硕士学位论文.2007年4月.18-30.
[28]姚水才,雷良莺等.区域卫生规划指导手册[M].人民卫生出版社.1997年第1版,32-43.
[29]傅慕韬.珠海市卫生资源配置研究.中山大学硕士学位论文.2007年5月.20-33.
[30]Department of Health and Social Security,Review of the Resource Allocation Working Party Formula[R].Report by the NHS Management Board,1986:86.
[31]Mcdermort R,Beaver C.Models of horizontal equity in resource allocation in aboriginal health.Aust-N-Z-j-Public-Health.1996 Feb;20(1):13-15.
[32]Adams-O.Manmagement of human resources in health care:the Canadian experience.Health-Econ.1992;1(2):131-150.
[33]Carr-Hill,RoyA et al.Allocating Resources to Health Authorities;Development of Method for Small Area Analysis Use of in patient Services.BMJ,1990,309(4):1046-1050.
[34]Kateker L V.Resource allocation—what is the first priority?J Med Ethics,1992,18(2):99-100.
[35]Featherstone N.Health systems planning at a state level:New Jersey.Am J Surg,1994,167(2):241-243.
[36]B.Abel Smith.The introduction to health planning,policy and financing,London,Longman press.1994,41-42.
[37]Bourgeois-D,Leclercq-MH,Barmes-DE.The application of the theoretical model WHO/FDI planning system to an industrialized country.France.Int-Dent-J.1993Feb.43(1):50-60.
[38]Brand-H,Menke-R.Need-based resource allocation-experiences with the RAWP formula in Great Britain.Gesundheitswesen.1997,59(7):441-450.
[39]Reid-U.Human resources in nursing:determining requirements and skills,Int-Nusrs-Rev.1993,40(4):119-120.
[40]Mooney G.Vertical equity in health care resource allocation.Health Policy,1997,39(1):79-87.
[41]Tavlor J.W.The role of risk in consumer behavior.Journal of Marketing. 1974.
[42]Cingranelli,D.L.Race.Politics and Elites.Testing Alternative Models of Municipal Services Distribution.American Journal of Political Science.Vol25.1981.
[43]Grossman,M.On the concept of health capital and the demand for health.Journal of Political Economy. 1972,223—225.
[44]Richard L.Morrilland John Symons.Efficiency and Equility Aspects of Optimum Location.Geographical Analysis. 1977.
[45]Eaton D,Daskin M S,Simmons D,et al.Determining emergency medical service vehicle deployment in Austin.Texas.Interfaces. 1985,(15)
[46]Thomas,L.Hall,China health manpower planning model, 1989.
[2]姜向群:《老年社会保障制度—历史与变革》,中国人民大学出版社出版,2005,第228页。
[3]《国外老龄问题》,甘肃人民出版社,1987。
[4]张力平:《生物心理社会医学模式的老人健康状况研究方法》,《中国社会医学》,1985年第1期。
[6]卫生技术人员是指卫生机构中医生、护理人员、药剂人员、检验人员等卫生技术人员。
[1]北京市统计局.北京市2006年国民经济和社会发展统计公报[M].中国统计出版社,2007年1月.
[2]青岛市卫生局.采用调整卫生机构去优化卫生资源配置[J].中华医院管理杂志.1999,15:202-204.
[3]封润华.近年来北京各区县人口地域分布变化的研究[J].人口与经济.2006,4:39-42.
[4]张倩.我国人口老龄化与政府在老龄产品和服务提供中的角色.北京大学在职攻读专业硕士学位论文.2007年3月,31-33.
[5]杜鹏.人口老龄化与老龄问题[M].中国人口出版社,2006年2月第1版.
[6]杨彦.北京市老年人力资源开发研究.首都经济贸易大学硕士学位论文,2004年3月,6-10.
[7]张纯,曹广忠.北京市人口老龄化的空间特征及影响因素[J].城市人口.2007,2:56-61.
[8]田雪原,沙吉才,杨子慧.中国老年人口(人口)[M].社会科学文献出版社.2007年4月第2版.
[9]汤哲,孟琛.北京市人口老龄化的发展趋势及其老年卫生保健工作现状[J].老年医学与保健.2000,3:149-150.
[10]郭子恒.医院管理学[M].人民卫生出版社.1983年8月第1版.
[11]李笃志.我国医院的发展模式研究.对外经济贸易大学硕士学位论文,2004年10月,1-3.
[12]高明.福建省卫生资源优化配置研究.福建师范大学硕士毕业论文,2006年9月,25-30.
[13]李倩.湖北省卫生资源配置的效率和公平性研究.博士毕业论文.2004年3月,52-57.
[14]黄荣清.1980年代以来北京市城市化过程中人口分布的变化[J].人口研究.2005,(5):19-26.
[15]刘莉.衡阳市城市医疗资源配置与运行状况的调查研究.中南大学硕士学位论文.2007年5月,7-10.
[16]冯建武.2004年温州市医疗资源配置分析.华东师范大学硕士学位论文.2006年9月,36-40.
[17]王雯菲,张文新.改革开放以来北京市人口分布及其演变[J].人口研究.2001,25(1):62-66.
[18]张文新.北京市人口分布与服务设施分布的协调性分析[J].北京社会科学.2004,(1):78-84.
[19]卢明名.我国人口老龄化对经济发展的影响研究.东北师范大学硕士学位论文.2007年5月,2-4.
[20]汤哲,方向华,项曼君,吴晓光,刁丽君,刘宏军.北京市老年人卫生服务需求研究[J].中华医院管理杂志.2004,20(8):464-469.
[21]张强,张琼,李宁秀.成都市城市社区老年人健康相关认知及行为研究[J].四川大学学报(医学版).2007,38(3):480-483.
[22]王德文,林维文,周天枢.福州市老年人慢性病现状调查.中国公共卫生.2004,20(10):1242-1243.
[23]胡至毅,张兆干.城市饭店的空间布局分析——以南京市为例.经济地理.2002,22(1):106-110.
[24]张文忠.经济区位论[M].北京出版社.2000,150-200.
[25]冯建,周一星.1990年代北京市人口空间分布的最新变化[J].城市规划.2003,27(5):55-62.
[26]冯建,周一星.杭州市人口的空间变动与郊区化研究[J].城市规划.2002,26(1):58-65.
[27]刘雪.人口老龄化背景下城镇老年人医疗需求研究.吉林大学硕士学位论文.2007年4月.18-30.
[28]姚水才,雷良莺等.区域卫生规划指导手册[M].人民卫生出版社.1997年第1版,32-43.
[29]傅慕韬.珠海市卫生资源配置研究.中山大学硕士学位论文.2007年5月.20-33.
[30]Department of Health and Social Security,Review of the Resource Allocation Working Party Formula[R].Report by the NHS Management Board,1986:86.
[31]Mcdermort R,Beaver C.Models of horizontal equity in resource allocation in aboriginal health.Aust-N-Z-j-Public-Health.1996 Feb;20(1):13-15.
[32]Adams-O.Manmagement of human resources in health care:the Canadian experience.Health-Econ.1992;1(2):131-150.
[33]Carr-Hill,RoyA et al.Allocating Resources to Health Authorities;Development of Method for Small Area Analysis Use of in patient Services.BMJ,1990,309(4):1046-1050.
[34]Kateker L V.Resource allocation—what is the first priority?J Med Ethics,1992,18(2):99-100.
[35]Featherstone N.Health systems planning at a state level:New Jersey.Am J Surg,1994,167(2):241-243.
[36]B.Abel Smith.The introduction to health planning,policy and financing,London,Longman press.1994,41-42.
[37]Bourgeois-D,Leclercq-MH,Barmes-DE.The application of the theoretical model WHO/FDI planning system to an industrialized country.France.Int-Dent-J.1993Feb.43(1):50-60.
[38]Brand-H,Menke-R.Need-based resource allocation-experiences with the RAWP formula in Great Britain.Gesundheitswesen.1997,59(7):441-450.
[39]Reid-U.Human resources in nursing:determining requirements and skills,Int-Nusrs-Rev.1993,40(4):119-120.
[40]Mooney G.Vertical equity in health care resource allocation.Health Policy,1997,39(1):79-87.
[41]Tavlor J.W.The role of risk in consumer behavior.Journal of Marketing. 1974.
[42]Cingranelli,D.L.Race.Politics and Elites.Testing Alternative Models of Municipal Services Distribution.American Journal of Political Science.Vol25.1981.
[43]Grossman,M.On the concept of health capital and the demand for health.Journal of Political Economy. 1972,223—225.
[44]Richard L.Morrilland John Symons.Efficiency and Equility Aspects of Optimum Location.Geographical Analysis. 1977.
[45]Eaton D,Daskin M S,Simmons D,et al.Determining emergency medical service vehicle deployment in Austin.Texas.Interfaces. 1985,(15)
[46]Thomas,L.Hall,China health manpower planning model, 1989.