我国基层医疗卫生机构卫生资源配置的公平性研究

Equity of Health Resource Distribution in Primary Healthcare Institutions in China

目的探讨2012—2015年我国基层医疗卫生机构卫生资源配置的发展趋势及公平性,为后续研究和卫生政策制定提供依据。方法以2013年《中国卫生统计年鉴》和2014—2016年《中国卫生和计划生育统计年鉴》为资料来源,收集2012—2015年我国及各经济区基层医疗卫生机构数、床位数及卫生技术人员数。分析我国基层医疗卫生机构卫生资源配置情况及变化趋势,并采用基尼系数和泰尔指数进行公平性分析。结果 2012—2015年,我国基层医疗卫生增长了8 150个机构、89 572张床位及205 950名卫生技术人员,年均增长率分别为0.30%、2.21%及3.24%。2012—2015年我国基层医疗卫生机构数的基尼系数分别为0.192、0.191、0.192、0.191;泰尔指数分别为0.066 2(区域内贡献率比区域间贡献率:58.91%比41.09%)、0.066 6(57.81%比42.19%)、0.066 6(57.81%比42.19%)、0.066 2(58.36%比41.64%)。我国基层医疗卫生机构床位数的基尼系数分别为0.166、0.168、0.174、0.178;泰尔指数分别为0.054 8(53.55%比46.45%)、0.057 1(52.79%比47.21%)、0.061 1(51.32%比48.68%)、0.063 1(52.12%比47.88%)。我国基层医疗卫生机构卫生技术人员数的基尼系数分别为0.089、0.096、0.091、0.090;泰尔指数分别为0.013 2(86.20%比13.80%)、0.014 9(78.73%比21.27%)、0.013 1(77.60%比22.40%)、0.013 0(73.99%比26.01%)。结论我国基层医疗卫生机构卫生资源配置的总体公平性较好,且卫生技术人员数的公平性优于机构数和床位数,但区域内差异大于区域间差异,建议注重各区域内部的基层医疗卫生机构卫生资源配置的公平性。

Objective To evaluate the trend and equity of health resource distribution in primary healthcare institutions in China during 2012 to 2015,so as to provide an evidence for further studies and the formulation and enaction of related policies. Methods From China＇s Health Statistics Yearbook 2013,China＇s Health And Family Planning Statistical Yearbook 2014,China＇s Health And Family Planning Statistical Yearbook 2015,China＇s Health And Family Planning Statistical Yearbook 2016,we obtained the number of primary healthcare institutions,number of beds and number of primary healthcare providers in primary healthcare institutions in China from 2012 to 2015,and analyzed the status and trend of health resource distribution during the period,and explored its equity by using Gini coefficient and Theil index. Results From 2012 to2015,the number of primary healthcare institutions, number of beds and primary healthcare providers in these institutions increased by 8 150, 89 572 and 205 950 respectively, with an annual growth rate of 0. 30%, 2. 21% and 3. 24%,respectively. From 2012 to 2015,the Gini coefficient for the distribution of primary healthcare institutions in China were 0. 192,0. 191,0. 192,0. 191,respectively; Theil index for the distribution of them respectively were 0. 066 2,0. 066 6,0. 066 6,and 0. 066 2; Intra-region contribution rate was found to be higher than inter-region contribution rate for Theil index in each year of this period（ 58. 91% vs 41. 09% in 2012,57. 81% vs 42. 19% in 2013,57. 81% vs 42. 19% in 2014,58. 36% vs41. 64% in 2015）. The Gini coefficient for the distribution of beds in primary healthcare institutions in China were 0. 166,0. 168,0. 174,0. 178,respectively during 2012 to 2015; Theil index for the distribution of them respectively were 0. 054 8,0. 057 1,0. 061 1,and 0. 063 1; Intra-region contribution rate was found to be higher than inter-region contribution rate for Theil index in each year of this period（ 53. 55% vs 46. 45% in 2012,52. 79% vs 47. 21% in 2013,51. 32% vs 48. 68% in2014,52. 12% vs 47. 88% in 2015）. The Gini coefficient for the distribution of the primary healthcare providers in primary healthcare institutions in China from 2012 to 2015 respectively were 0. 089,0. 096,0. 091 and 0. 090; Theil index for the distribution of them respectively were 0. 013 2,0. 014 9,0. 013 1 and 0. 013 0; Intra-region contribution rate was found to be higher than inter-region contribution rate for Theil index in each year of this period（ 86. 20% vs 13. 80% in 2012,78. 73% vs21. 27% in 2013,77. 60% vs 22. 40% in 2014,73. 99% vs 26. 01% in 2015）. Conclusion The equity of health resource distribution in primary healthcare institution in China during 2012—2015 was reasonable on the whole. The distribution equity of the number of primary healthcare providers was better than that of primary healthcare institutions and beds in these institutions. However,intra-region differences were greater than inter-region differences in the distribution equity of these three items. Therefore,priority should be given to the improvement of intra-region equity of health resource distribution in primary healthcare institutions.