中国省际全科医生数及影响因素的空间计量分析

Provincial Distribution and Influencing Factors of General Practitioners in China:a Spatial Econometric Analysis

背景随着我国经济、社会等的变化和发展,亟须全科医生的培养发展及全科医生制度的建立完善。我国政策层面在不断关注和支持全科医生队伍建设,而现有对于全科医生的研究,几乎没有考虑到全科医生的空间相关性。目的对我国省际全科医生数及影响因素进行空间计量分析,为全科医生数量配置提供依据。方法利用2013-2017年的《中国卫生和计划生育统计年鉴》和2017年的《中国统计年鉴》数据,采用空间自相关检验和空间计量模型对我国各省(自治区、直辖市)全科医生数及影响因素进行分析。结果 2016年我国每万人全科医生数为1.51人,东部最高,为2.03人。2016年全国各省(自治区、直辖市)全科医生数全局莫兰指数(Moran’s I)=0.219(P<0.05)。空间误差模型(SEM)中λ=0.211(P<0.10),且模型评价指标优于普通最小二乘法(OLS)。SEM结果显示,全科医生数与政府卫生支出呈正相关(P<0.05)。结论我国全科医生数在快速增长但存在较大缺口,全科医生数存在省际空间自相关性和地区不均衡性,且主要与地区发展水平和政府卫生支出有关,增加全科医生数量需提高政府卫生支出。

Background The changes and development of China’s economy and society urgently require the training and development of general practitioners(GPs)and the improvement of GP system.Also,the construction of GPs workforce has received attentions and support at the policy level.However,there are very few spatial econometric studies about GPs in China.Objective To perform a spatial econometric analysis of provincial distribution and associated factors of GPs in China,offering a theoretical basis for geographical allocation of GPs.Methods Data were collected from 5 volumes of China’s Health and Family Planning Statistical Yearbook(2013-2017),and China Statistical Yearbook 2017.Spatial autocorrelation test and spatial econometric models were used to analyze provincial distribution and associated factors of GPs in China.Results In 2016,the number of GPs per 10 000 people in China was 1.51.In eastern China,it was 2.03,which was higher than of central and western China.In 2016,the global Moran’s I for provincial distribution of GPs was 0.219(P<0.05).In spatial error model(SEM),λ=0.211(P<0.10),and model evaluation indices of SEM were superior to those of OLS.The results showed that the number of GPs was positively correlated with government health expenditure(P<0.05).Conclusion In general,the number of GPs in China is increasing rapidly,but is relatively insufficient to satisfy the health needs of the people.Moreover,there are interprovincial spatial autocorrelation and regional imbalance in the number of GPs,which are mainly related to the differences in regional development level and government health expenditure.To increase the number of GPs,government health expenditure should be increased.