山东省十七地市卫生资源配置公平性分析与预测
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摘要
前言
卫生资源是指提供各种卫生服务所使用的投入要素的总和,包括硬件资源(即提供各种卫生服务所投入的全部资本和人力)和软件资源(卫生信息、卫生技术、卫生管理、卫生服务能力等内容),如卫生技术人员数、床位数、卫生事业经费占国家财政支出的比值和医生护士的比值等,都是衡量该国家或地区在一定时期内卫生资源水平的重要指标,但是,一个国家的卫生资源总量是有限的,因此如何使有限的卫生资源得到合理、公平和优化配置,已成为卫生服务研究领域的重点。近年来,世界各国政府在推动卫生服务体系改革过程中,也更加注重卫生资源的合理、公平配置。
卫生服务公平性是世界卫生组织对各国卫生系统绩效评估的一项重要指标,包括卫生资源配置公平性、卫生服务利用公平性和卫生服务筹资公平性三类,卫生资源配置公平性是其他两项内容的重要前提。我国30年的医疗改革进行到今天,卫生资源配置的公平和效率问题的急迫性已经成为阻碍医疗卫生事业发展的主要矛盾。
新中国成立以来,特别是自改革开放以来,随着综合经济实力显著增强,山东省的卫生事业也取得了长足发展。山东省财政对医疗卫生事业的投入逐年增加,为了发展卫生事业,制定了一系列规划、方针、政策,医疗卫生服务系统也日趋完善,医疗卫生资源总体已颇具规模,卫生服务能力明显增强,为促进社会经济可持续又好又快发展方面做出了积极贡献。
卫生资源配置公平性对优化医疗资源配置具有极度重要的意义。近年来,随着更多的社会资源进入卫生服务领域的愿望日趋强烈,如何在新形势下维持卫生资源配置公平性,把握卫生事业发展趋势、合理配置和充分利用医疗卫生资源对促进卫生事业有序发展意义重大。
研究目的
根据《卫生年鉴》等权威数据,通过现状研究系统分析山东省十七地市卫生资源配置现状,通过绘制卫生资源按人口、地域面积、GDP分布洛伦兹曲线、计算相应Gini系数全而评价卫生资源配置的公平性状况,并对主要卫生资源定量预测,提出山东省卫生资源配置发展和调整的政策建议,为科学设计卫生资源配置方案提供理论依据。
研究方法
本研究采用系统分析法,从整体的观念分析卫生资源配置问题,通过对与相关的复杂问题进行定性与定量结合的分析研究,调整系统结构,以达到最优设计、最优控制和最优管理的目标；采用洛伦茨曲线(Lorenz Curve)和基尼系数(Gini Coefficient)评价卫生资源配置现状的公平性；采用时间序列(Time Series)方法根据过去卫生资源发展趋势力对未来发展进行预测,以全面分析、评价山东省卫生资源现状,为卫生资源配置提供政策建议。
主要结果
1、通过绘制洛伦兹曲线计算,山东省十七地市卫生人力Gini系数为0.148,公平性较高,其中,卫生人力资源总量按人口分布Gini系数为0.050、按地域面积分布Gini系数为0.093、按GDP分布Gini系数为0.302；
2、通过绘制洛伦兹曲线计算,山东省十七地市卫生机构总资产Gini系数为0.169,公平性较高,其中,卫生机构总资产按人口分布Gini系数为0.089、按地域面积分布Gini系数为0.271、按GDP分布Gini系数为0.146；
3、通过绘制洛伦兹曲线计算,山东省十七地市卫生机构总床位Gini系数为0.146,公平性较高,其中,卫生机构总床位按人口分布Gini系数为0.087、按地域面积分布Gini系数为0.128、按6DP分布Gini系数为0.223；
4、综合人口公平性(Gini系数0.075)、地域面积公平性(Gini系数0.164)、GDP公平性(Gini系数0.224)三个维度的横向比较,可以发现,山东省十七地市卫生资源分布中,按GDP分布公平性最低；
5、通过时间序列研究拟合方程,预测2010-2014年山东省卫生人力资源总量分别为523910人、551819人、581215人、612176人、644787人,年均增速4.86%：
6、通过时间序列研究拟合方程,预测2010-2014年山东省床位总量分别为：401330张、464005张、539921张、630386张、736705张,年均增速10.59%。
结论
1、从横断面分析来看,其他省市比较,山东卫生资源总量已达到相当规模,但人均占有量较低,因此在卫生资源配置过程中,应注重公平,兼顾效率；
2、山东省十七地市卫生人力资源、卫生机构总资产、床位总量分布绝对公平(Gini系数在0-0.2区间范围内)：但卫生资源按GDP分布Gini系数得分低于按人口、地域面积分布Gini系数,说明6DP公平性仍有待提高,对于经济发展水平较高的地市,如山东半岛蓝色经济区、省会城市群经济圈城市,应在保持现有卫生资源的前提下积极引入社会资本而不应过多占用公共资源；对于欠发达地区,财政应增加专项投资、增加卫生资源供给、优化存量资源和提高基本医疗卫生服务体系,通过政策、卫生服务规划等加强对经济欠发达地区的支持力度；
3、从时间序列分析看,近十年来,山东省卫生资源增长迅速,与山东省国民经济和社会发展水平相匹配,通过拟合模型预测,山东省在预测年份内卫生资源仍将保持较高速度增长势头,提示卫生行政部门在卫生事业高速发展的同时,应重视不断优化结构,同时加强政府在制度、规划、融资、服务、监管职责,根据不同经济发展水平的地区居民的健康需求的变化调整资源配置,制定科学可行的卫生服务体系的总体发展规划,避免无序发展；更应保持卫生服务公益性,促进卫生资源配置的公平与正义不断向前迈进。
Preface:
The sanitation resources refer to a variety of factors in total contributed to the hygiene services, including facility resources, namely the entire capital and human resources invested for the hygiene services, and the soft resources such as the hygiene information, technobgy, administration, services and so forth. Be specific, it covers the number of the hygiene technical personnel, the bed numbers in hospital wards, the ratio of sanitation budget in the total fiscal spending and proportion of doctors and nurses. All these factors work a whole to determine the sanitation resources level in a particular country or a region at a given background. However, the national sanitation resources in total is limited and, therefore, an optimization of such resources has become an essence in the field of hygiene service studies. Recently many countries" governments are devoting to a reform of sanitation service system and paying closer attention to an equal and reasonable resources distribution.
The fairness in the sanitation services is one of the key items in evaluating a particular country's hygiene system by the WHO. It coasists of the equity of the sanitation resources distribution, the impartial access to the hygiene services and a just service fund-raising, while the first item is the prerequisite of the other counterparts. The problems regarding fair and efficient sanitation resources distribution have become outstanding obstacles that decelerate the medical care development.
Since the establishment of PRC, especially the reform and open policy, the medical care in Shandong has promoted rapidly as its comprehensive economical strength enhanced. The fiscal investment kept ascending. In fully developing the medical care, a series of plans, polices and guiding principles are set up. Furthermore, the medical service system is improving and the service delivery ability has upgraded significantly as the medical care resources thrive. It makes considerable contribution to the China's sustainable development.
A fair distribution of sanitation resources heavily influences the optimization of the medical resources allocation. In recent years, as the desire is increasing that social resources enter into medical care industry, the fairness of hygiene resource distribution and the optimization as well as a full use of resources determine the medical service's development in China.
Research purpose
The objective is to make proposals regarding sanitation resources redistribution, adjustment and policy-making, and to provide theoretic reference for scientifically planning the hygiene resources distribution in the future. The result is based on the official statistics from Hygiene, The Annual Report, and the conclusion is reached in3steps:1systematically analyzing the current sanitation resources condition of17cities and regions in Shandong;2charting Lorenz Curve about fairness of population, territory area and GDP, and calculate Gini coefficient to estimate the resource distribution's current condition;3providing quantitative prediction for critical medical resources.
The main results
1According to the Lorenz curve's results, the HR Gini coefficient in17cities and regions in Shandong is0.148which indicates a higher fairness. The Gini coefficient for fairness of population, territory area and GDP are0.0050,0.093and0.302respectively.
2Based on the results from Lorenz curves, the total assets Gini coefficient in17cities and regions in Shandong is0.169which indicates a higher fairness. The Gini coefficient for fairness of population, territory area and GDP are0.089,0.271and0.146respectively.
3The total assets Gini coefficient in17cities and regions in Shandong is0.146which indicates a higher fairness. The Gini coefficient for fairness of population, territory area and GDP are0.087,0.128and0.223respectively.
4The Gini coefficient for fairness of populatbn, territory area and GDP are0.075,0.164and0.224respectively. It can be found that with a3dimensions'horizontal comparison, the fairness in GDP maintains the lowest level in the17Shandong cities and regions'hygiene resources distribution.
5By utilizing a chronicle fitted equation, the predicated total HR resources through2010to2014would be523910,551819,581215,612176and644787(person) with a growth rate of4.86%.
6Similarly, by utilizing a chronicle fitted equation; the predicated total hospital bed number in Shandong2010-2014would be401330,464005,539921,630386and736705with a growth rate of10.59%.
Conclusion
1An analysis based on the information from the cross-section indicates that compared with other provinces, the sanitation resource is rich in total but the per capita Ls relatively low, therefore, fairness comes first which is followed by efficiency when distributing the hygiene resources.
2According to the Gini coefficient's range0-0.2, the fiR resources, health care organization's total assets and hospital bed number are convinced to be fair, the coefficient of GDP fairness is lower than those in population and territory area, and that relieves a need for promotion in GDP fairness. The regions with a fast economy development such as blue economic zone in Shandong peninsula and economical circle around Jinan should engage in introducing social capital and restrict public resources over occupation with a prerequisite maintaining the present hygiene resources. For the underdevebped regions, fiscal investments shall be increased to strengthen the economical support combing preferential policies and medical care planning.
3Chronically, in the past decade, the sanitation resources in Shandong witnessed a fast promotion which matched the provincial economical development. Through the results from the fitted equation, Shandong did and will keep a quick growth during2010-2014. Recommendations:work restructures are required to implement and the government's responsibilities in policy-making, planning, financing, service and regulating should be deepened; optimize resources in the light of various economical development and diversified residents'health needs; establish scientific and feasible hygiene service system and overall upgrade plan in case chaos development; attach importance to public welfare and constantly promote fairness in the sanitation reso urces d i s tr ib ut io n.
卫生资源是指提供各种卫生服务所使用的投入要素的总和,包括硬件资源(即提供各种卫生服务所投入的全部资本和人力)和软件资源(卫生信息、卫生技术、卫生管理、卫生服务能力等内容),如卫生技术人员数、床位数、卫生事业经费占国家财政支出的比值和医生护士的比值等,都是衡量该国家或地区在一定时期内卫生资源水平的重要指标,但是,一个国家的卫生资源总量是有限的,因此如何使有限的卫生资源得到合理、公平和优化配置,已成为卫生服务研究领域的重点。近年来,世界各国政府在推动卫生服务体系改革过程中,也更加注重卫生资源的合理、公平配置。
卫生服务公平性是世界卫生组织对各国卫生系统绩效评估的一项重要指标,包括卫生资源配置公平性、卫生服务利用公平性和卫生服务筹资公平性三类,卫生资源配置公平性是其他两项内容的重要前提。我国30年的医疗改革进行到今天,卫生资源配置的公平和效率问题的急迫性已经成为阻碍医疗卫生事业发展的主要矛盾。
新中国成立以来,特别是自改革开放以来,随着综合经济实力显著增强,山东省的卫生事业也取得了长足发展。山东省财政对医疗卫生事业的投入逐年增加,为了发展卫生事业,制定了一系列规划、方针、政策,医疗卫生服务系统也日趋完善,医疗卫生资源总体已颇具规模,卫生服务能力明显增强,为促进社会经济可持续又好又快发展方面做出了积极贡献。
卫生资源配置公平性对优化医疗资源配置具有极度重要的意义。近年来,随着更多的社会资源进入卫生服务领域的愿望日趋强烈,如何在新形势下维持卫生资源配置公平性,把握卫生事业发展趋势、合理配置和充分利用医疗卫生资源对促进卫生事业有序发展意义重大。
研究目的
根据《卫生年鉴》等权威数据,通过现状研究系统分析山东省十七地市卫生资源配置现状,通过绘制卫生资源按人口、地域面积、GDP分布洛伦兹曲线、计算相应Gini系数全而评价卫生资源配置的公平性状况,并对主要卫生资源定量预测,提出山东省卫生资源配置发展和调整的政策建议,为科学设计卫生资源配置方案提供理论依据。
研究方法
本研究采用系统分析法,从整体的观念分析卫生资源配置问题,通过对与相关的复杂问题进行定性与定量结合的分析研究,调整系统结构,以达到最优设计、最优控制和最优管理的目标；采用洛伦茨曲线(Lorenz Curve)和基尼系数(Gini Coefficient)评价卫生资源配置现状的公平性；采用时间序列(Time Series)方法根据过去卫生资源发展趋势力对未来发展进行预测,以全面分析、评价山东省卫生资源现状,为卫生资源配置提供政策建议。
主要结果
1、通过绘制洛伦兹曲线计算,山东省十七地市卫生人力Gini系数为0.148,公平性较高,其中,卫生人力资源总量按人口分布Gini系数为0.050、按地域面积分布Gini系数为0.093、按GDP分布Gini系数为0.302；
2、通过绘制洛伦兹曲线计算,山东省十七地市卫生机构总资产Gini系数为0.169,公平性较高,其中,卫生机构总资产按人口分布Gini系数为0.089、按地域面积分布Gini系数为0.271、按GDP分布Gini系数为0.146；
3、通过绘制洛伦兹曲线计算,山东省十七地市卫生机构总床位Gini系数为0.146,公平性较高,其中,卫生机构总床位按人口分布Gini系数为0.087、按地域面积分布Gini系数为0.128、按6DP分布Gini系数为0.223；
4、综合人口公平性(Gini系数0.075)、地域面积公平性(Gini系数0.164)、GDP公平性(Gini系数0.224)三个维度的横向比较,可以发现,山东省十七地市卫生资源分布中,按GDP分布公平性最低；
5、通过时间序列研究拟合方程,预测2010-2014年山东省卫生人力资源总量分别为523910人、551819人、581215人、612176人、644787人,年均增速4.86%：
6、通过时间序列研究拟合方程,预测2010-2014年山东省床位总量分别为：401330张、464005张、539921张、630386张、736705张,年均增速10.59%。
结论
1、从横断面分析来看,其他省市比较,山东卫生资源总量已达到相当规模,但人均占有量较低,因此在卫生资源配置过程中,应注重公平,兼顾效率；
2、山东省十七地市卫生人力资源、卫生机构总资产、床位总量分布绝对公平(Gini系数在0-0.2区间范围内)：但卫生资源按GDP分布Gini系数得分低于按人口、地域面积分布Gini系数,说明6DP公平性仍有待提高,对于经济发展水平较高的地市,如山东半岛蓝色经济区、省会城市群经济圈城市,应在保持现有卫生资源的前提下积极引入社会资本而不应过多占用公共资源；对于欠发达地区,财政应增加专项投资、增加卫生资源供给、优化存量资源和提高基本医疗卫生服务体系,通过政策、卫生服务规划等加强对经济欠发达地区的支持力度；
3、从时间序列分析看,近十年来,山东省卫生资源增长迅速,与山东省国民经济和社会发展水平相匹配,通过拟合模型预测,山东省在预测年份内卫生资源仍将保持较高速度增长势头,提示卫生行政部门在卫生事业高速发展的同时,应重视不断优化结构,同时加强政府在制度、规划、融资、服务、监管职责,根据不同经济发展水平的地区居民的健康需求的变化调整资源配置,制定科学可行的卫生服务体系的总体发展规划,避免无序发展；更应保持卫生服务公益性,促进卫生资源配置的公平与正义不断向前迈进。
Preface:
The sanitation resources refer to a variety of factors in total contributed to the hygiene services, including facility resources, namely the entire capital and human resources invested for the hygiene services, and the soft resources such as the hygiene information, technobgy, administration, services and so forth. Be specific, it covers the number of the hygiene technical personnel, the bed numbers in hospital wards, the ratio of sanitation budget in the total fiscal spending and proportion of doctors and nurses. All these factors work a whole to determine the sanitation resources level in a particular country or a region at a given background. However, the national sanitation resources in total is limited and, therefore, an optimization of such resources has become an essence in the field of hygiene service studies. Recently many countries" governments are devoting to a reform of sanitation service system and paying closer attention to an equal and reasonable resources distribution.
The fairness in the sanitation services is one of the key items in evaluating a particular country's hygiene system by the WHO. It coasists of the equity of the sanitation resources distribution, the impartial access to the hygiene services and a just service fund-raising, while the first item is the prerequisite of the other counterparts. The problems regarding fair and efficient sanitation resources distribution have become outstanding obstacles that decelerate the medical care development.
Since the establishment of PRC, especially the reform and open policy, the medical care in Shandong has promoted rapidly as its comprehensive economical strength enhanced. The fiscal investment kept ascending. In fully developing the medical care, a series of plans, polices and guiding principles are set up. Furthermore, the medical service system is improving and the service delivery ability has upgraded significantly as the medical care resources thrive. It makes considerable contribution to the China's sustainable development.
A fair distribution of sanitation resources heavily influences the optimization of the medical resources allocation. In recent years, as the desire is increasing that social resources enter into medical care industry, the fairness of hygiene resource distribution and the optimization as well as a full use of resources determine the medical service's development in China.
Research purpose
The objective is to make proposals regarding sanitation resources redistribution, adjustment and policy-making, and to provide theoretic reference for scientifically planning the hygiene resources distribution in the future. The result is based on the official statistics from Hygiene, The Annual Report, and the conclusion is reached in3steps:1systematically analyzing the current sanitation resources condition of17cities and regions in Shandong;2charting Lorenz Curve about fairness of population, territory area and GDP, and calculate Gini coefficient to estimate the resource distribution's current condition;3providing quantitative prediction for critical medical resources.
The main results
1According to the Lorenz curve's results, the HR Gini coefficient in17cities and regions in Shandong is0.148which indicates a higher fairness. The Gini coefficient for fairness of population, territory area and GDP are0.0050,0.093and0.302respectively.
2Based on the results from Lorenz curves, the total assets Gini coefficient in17cities and regions in Shandong is0.169which indicates a higher fairness. The Gini coefficient for fairness of population, territory area and GDP are0.089,0.271and0.146respectively.
3The total assets Gini coefficient in17cities and regions in Shandong is0.146which indicates a higher fairness. The Gini coefficient for fairness of population, territory area and GDP are0.087,0.128and0.223respectively.
4The Gini coefficient for fairness of populatbn, territory area and GDP are0.075,0.164and0.224respectively. It can be found that with a3dimensions'horizontal comparison, the fairness in GDP maintains the lowest level in the17Shandong cities and regions'hygiene resources distribution.
5By utilizing a chronicle fitted equation, the predicated total HR resources through2010to2014would be523910,551819,581215,612176and644787(person) with a growth rate of4.86%.
6Similarly, by utilizing a chronicle fitted equation; the predicated total hospital bed number in Shandong2010-2014would be401330,464005,539921,630386and736705with a growth rate of10.59%.
Conclusion
1An analysis based on the information from the cross-section indicates that compared with other provinces, the sanitation resource is rich in total but the per capita Ls relatively low, therefore, fairness comes first which is followed by efficiency when distributing the hygiene resources.
2According to the Gini coefficient's range0-0.2, the fiR resources, health care organization's total assets and hospital bed number are convinced to be fair, the coefficient of GDP fairness is lower than those in population and territory area, and that relieves a need for promotion in GDP fairness. The regions with a fast economy development such as blue economic zone in Shandong peninsula and economical circle around Jinan should engage in introducing social capital and restrict public resources over occupation with a prerequisite maintaining the present hygiene resources. For the underdevebped regions, fiscal investments shall be increased to strengthen the economical support combing preferential policies and medical care planning.
3Chronically, in the past decade, the sanitation resources in Shandong witnessed a fast promotion which matched the provincial economical development. Through the results from the fitted equation, Shandong did and will keep a quick growth during2010-2014. Recommendations:work restructures are required to implement and the government's responsibilities in policy-making, planning, financing, service and regulating should be deepened; optimize resources in the light of various economical development and diversified residents'health needs; establish scientific and feasible hygiene service system and overall upgrade plan in case chaos development; attach importance to public welfare and constantly promote fairness in the sanitation reso urces d i s tr ib ut io n.
引文
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[37]尹爱田,黄冬梅,郑文贵,胡善菊,于贞杰,张德春,刘成凤.山东省医疗卫生单位补偿政策落实情况调查研究[J].中国卫生资源,2004,02：69-71.
[38]姬小荣,王禄生.我国中西部地区县域内卫生资源配置状况[J].中国卫生经济,2010,01：14-16.
[39]杨启佑,王天贵,马晓萍,甘淑君.卫生床位配置标准测算方法及其应用[J].中国卫生资源,2001，01.42-44.
[40]罗荣,潘晓平,汤学军.省级妇幼保健机构床位配置现状及其床位利用效率的综合评价[J].中国妇幼保健,2006,11：1462-1464.
[41]何敬一,朱洪彪,王新朝,杨晓华,张世敬.河南省医院床位配置中的问题及解决途径[J].中国卫生经济,1998,10：56-57.
[42]刘奕然,李长平,马骏.2002～2008年天津市18个区县卫生资源配置公平性分 析[J].中国卫生事业管理,2010,11：754-756.
[43]张艳丽,马安宁,张洪才,冀春亮.关于实现卫生资源优化配置的思学[J].中国卫生资源,2007,02：56-57.
[44]桑海云,姜宝法.山东省卫生资源配置的空间公平性分析[J].中国卫生事业管理,2008,12：798-799.
[45]李倩,陈辉,胡国善,曹艳清,胡春平,卢祖洵.1949～2003年湖北省卫生资源配置与利用效率的动态分析[J].中国卫生事业管理,2006,01：34-36.
[46]李晓淳,刘书文,刘骏,贾睿.区域性卫生规划及卫生资源配置标准的比较分析[J].中国卫生事业管理,2003,10：616-617+637.
[47]卓凯星,颜丙约,杨启佑,郭秀卿,邓茂英.卫生资源优化配置研究[J].中国卫生资源,1999,03：5-7.
[48]李刚,王俊,杨涛,姜淑丽,徐凌中，孟庆跃,雷海潮，胡善联.英国为甚资源配置思想与我国卫生资源配置模式的改革[J].中国卫生资源,1999,04：43-45.
[49]陈化.广州市卫生资源配置的合理性研究[J].中国初级卫生保健,2007,06.9-11.