新医改前后中国基层卫生资源配置公平性分析

Equity in basic health resources allocation before and after health reform in China

目的分析中国新医改前后基层卫生资源配置的公平状况。方法采用基尼系数和泰尔指数方法来探讨不同区域间的基层卫生资源配置的差距,分析新医改前后卫生资源的分布变化情况。结果新医改后中国乡镇卫生院人力、物力资源的基尼系数均有所下降,总支出的基尼系数则呈现出先降低后升高趋势;新医改后人力、物力的泰尔指数由0.431 85下降到0.255 21,总支出的泰尔指数则由0.527 58上升至3.618 09;区域内的泰尔指数贡献率远大于区域间的。结论基尼系数和泰尔指数均表明新医改后在人力、物力2个方面,基层卫生资源配置的公平性均有所提升,但财力方面指标下降;区域内的不公平是导致基层卫生资源配置不公平的主要原因。

Objective To analyze the fairness of rural basic health resources allocation before and after health re- form in China. Methods Using Theil index and Gird coefficient, we assessed disparities in health resources allocation in different areas and analyzed relevant data on regional health resources distribution before and after health reform. Results After the health reform, Gini coefficients for human and material resources of hospitals at township level showed a de- clining trend, but the Gird coefficient for total expenditure increased first then decreased;the Theil index for human and material resources declined from 0. 431 85 to 0. 255 21 ,while the Theil index for total expenditure rose from 0. 527 58 to 3.618 09. The contribution of inter-regional Theil index was much greater than that of within-region Theil index. Conclu- sion Based on Gird coefficients and Theil indexes for human and material resources, the equity in health resources allo- cation at grassroots level was improved but that in financial support was even worse after the health reform. The within- region inequity is a major factor responsible for the inequity in health resources allocation at grassroots level in China.