中国医疗卫生资源供给水平的空间均衡状态及其时间演变

Spatial Equilibrium State and Its Time Evolution of Medical Health Resource Supply Level in China

为正确认识医疗卫生资源空间分布的现状,以医疗卫生资源空间均衡状态及其时间演变趋势为研究内容,采用中国338个地级市为研究样本,运用核密度估计、基尼系数及其分解和LISA时间路径分析等方法,构建国家-区域-市域3个层次的空间均衡分析框架,定量刻画医疗卫生资源空间均衡状态及其时间演变特征。研究结果表明,医疗卫生资源的空间分布正在走向均衡;医疗卫生资源供给水平在三大区域之间的交错程度较高且呈现逐渐增高的趋势;在东部沿海到中部地区的过渡地带存在集中分布的低低集聚区,即医疗卫生资源供给水平同样存在＂京汕低谷带＂。

In the context of the national efforts to promote the equalization of medical and health services, to get a correct understanding of the status quo of equalization of medical and health resources and a scientific evaluation of the country to promote the equalization of medical and health services, this article discusses spatial equilibrium of medical and health resources and its time evolution, using the data of 338 cities in China as the research sample, using the medical resources supply level as a measure index of the health service. Based on the methods of kernel density estimation, Gini coefficient and its decomposition and LISA time path analysis, the spatial equilibrium analysis framework of state-region-city domain is constructed, and the spatial equilibrium state of medical and health resources and its temporal evolution are quantitatively described. The results show that： the spatial distribution of medical and health resources is moving towards equilibrium, and the crossed level of medical and health resources is higher between three regions. The high concentration area is mainly maintained in western Xinjiang, Tibet and Sichuan Region, the low and low agglomeration areas are scattered in the provinces such as Henan Province, Jiangxi Province and Guangxi Zhuang Autonomous Region. In particular, there is a concentrated distribution area in the transitional zone between the eastern coast and the central region, the level of medical and health resources supply exists＂Beijing-Shantou low belt＂,which is an underdeveloped area between two developed areas in Chinese eastern costal and Beijing-Guangzhou railway, and located in＂Beijing-Kowloon line＂（Beijing to Jiujiang） and the south extension of the＂Jiu Shan line＂（Jiujiang to Shantou） along the railway. Compared to economic developmentof＂Beijing-Shantou low belt＂, the medical and health resourcesin＂Beijing-Shantou low belt＂have a small span between the north and south, and a small east-west span. At the same time, the spatial and temporal path analysis of medical and health resources supply level indicates that the spatial pattern shows a strong stability. The relative length of the time route in the central and eastern regions is relatively small, and the supply level of medical and health resources is relatively slow. In particular, the＂Beijing-Shantou Troughs＂are basically in the areas with the lowest relative length. Time course curvature is generally small, indicating that the development of medical and health resources supply level has a relatively stable spatial dependence and spatial change direction, that is, strong spatial locking effect. The degree of equalization of medical and health resources has been significantly improved on the national scale, while the supply level of medical and health resources in the region begins to appear. This requires the government to change the support of medical and health services to achieve the full coverage from the basic public health support to the health care services behind the focus of support; at the same time, perfecting the transfer payment system, improving the ability of backward areas to provide medical and health services, and achieve health care resources reasonable allocation in the regions, which is also the connotation of＂everyone enjoys basic medical and health services＂.