2004～2016年新疆医疗卫生资源配置公平性与影响因素研究——基于“人口公平性”与“地理公平性”的综合视角

Research on the Equity and Influencing Factors of Health Resource Allocation in Xinjiang from 2004 to 2016: A Comprehensive Perspective Based on “Population Fairness” and “Geographical Equality”

目的:研究"人口公平性"与"地理公平性"下的新疆医疗卫生资源配置公平性与影响因素。方法:通过基尼系数分别按人口公平性与地理公平性分析新疆医疗卫生资源配置现状,并结合泰尔指数对区域内差异与区域间差异进行分析,以此对新疆医疗卫生资源配置的公平性有一个较为全面的评估;使用灰色关联模型对多个医疗卫生资源指标的影响因素进行分析,得到较为综合的影响因素排序结果。结果:新疆医疗卫生资源以人口公平性为衡量标准时基尼系数较低,以地理公平性为衡量标准时基尼系数偏高;泰尔指数也呈现相同的变化趋势。同时,通过对泰尔指数中区域差异贡献率的分析,得出区域内差异为医疗卫生资源配置差异的主要因素,其中北疆是造成该差异的主要原因;通过灰色关联模型对影响因素的分析,得出以人口公平性为衡量标准时人均GDP在影响因素中的排名最高,以地理公平性为衡量标准时财政收入分权在影响因素中的排名最高,在综合排名中财政收入分权更为重要。结论:提高对"地理公平性"的重视;调整北疆医疗卫生资源配置,增加东疆、南疆偏远地区的医疗卫生资源投入,同时继续发展经济,增加个人对医疗卫生服务的购买能力;增大地区政府的规划能力。

Objective To study the fairness and influential factors of allocation of medical and health resources in Xinjiang under the condition of"population fairness"and"geographical fairness". Methods According to the Gini coefficient,the status quo of the distribution of medical and health resources in Xinjiang was analyzed according to the population fairness and geographical fairness respectively. The regional differences and inter-regional differences were analyzed with the Theil index,and the distribution of medical and health resources in Xinjiang The fairness of the health care system has a more comprehensive evaluation;using the gray relational model to analyze the influencing factors of multiple health resources indicators,and obtains a more comprehensive ranking of the influencing factors. Results In Xinjiang,the Gini coefficient was lower when the population fairness was used as the standard,and the Gini coefficient was higher when the geographical equity was the standard. The Theil index also showed the same trend. At the same time,through the analysis of the contribution rate of regional difference in the Theil index,it is concluded that the difference in the region is the main factor in the allocation of medical and health resources. Among them,the main cause of this difference is the northern region;the analysis of the influencing factors by the gray relational model,it is concluded that the per capita GDP ranks the highest among all the influencing factors when the population fairness is the standard. When the geographical equity is the standard,the fiscal decentralization has the highest ranking among the influencing factors,and the fiscal decentralization is more important in the comprehensive ranking. Conclusion: To increase attention to"geographical fairness";adjust the allocation of medical and health resources in northern Xinjiang,increase investment in medical and health resources in remote areas in eastern and southern Xinjiang while continuing to develop economy and increase personal purchasing power for medical and health services;Planning capacity of large regional governments.