健康扶贫视角下张家口卫生资源配置公平性研究

Study on the equity of health resource allocation in Zhangjiakou from the perspective of health poverty alleviation

目的探讨基于健康扶贫视角下张家口地区的卫生资源配置的合理性和公平性。方法收集2013年1月~2016年12月该区域的卫生医疗机构数、床位数、卫生技术人员数、执业(助理)医师数、注册护士数等数据,采用洛伦兹曲线、基尼系数对其常住人口和地域面积两个维度的公平性进行评价。结果2016年,张家口地区卫生机构资源配置的基尼系数为0.19,处于高度公平状态;卫生机构床位资源配置的基尼系数为0.28,处于比较公平状态;千人口护士基尼系数0.43,处于不公平状态;卫生资源按人口配置的基尼系数从高到低依次为千人口注册护士0.43,千人口医生0.34,千人口卫生技术人员0.34,千人口床位数0.28,千人口卫生机构0.19,护士资源的配置略显不公平;每千平方公里平均配有医疗机构1.04个,床位资源配置的基尼系数为0.55,处于非常不公平状态;每千平方公里平均配有卫生技术人员4.03人,专业技术人员配置的基尼系数为0.61,处于高度不公平状态;每千平方公里平均拥有医生1.49名,千平方公里医生基尼系数为0.56,处于非常不公平的状态;每千平方公里平均拥有护士0.12名,千平方公里护士基尼系数为0.63,处于高度不公平的状态;除了卫生机构外,其余资源配置均处于非常不公平的状态。2013~2016年,张家口地区卫生资源按人口配置的基尼系数变化不大,除了医疗卫生机构基尼系数2015年波动较大,且于次年降低至先前水平外,总体呈现下降的态势;医生按人口配置的基尼系数呈现略高的增加态势,按人口分布的基尼系数平均数为0.27,比较公平;各维度卫生资源按区域配置的基尼系数为0.53,呈现非常不公平的态势,其中护士的基尼系数较2016年有明显下降,卫生技术人员2014年突然降低,并于次年增加至前期水平后平稳降低;卫生机构基尼系数基本稳定,床位基尼系数略有增加,因此,各项医疗卫生资源按人口配置的基尼系数要优于按地域配置的基尼系数。结论近年来,张家口医疗卫生资源配置存在着地域不公平现象,医护比例失衡,资源显著集中且不合理。

Objective To explore the rationality and fairness of health resource allocation in Zhangjiakou area from the perspective of health poverty alleviation.Methods From January 2013 to December 2016,the number of health care institutions,beds,health technicians,the number of practitioners(assistant doctors)and registered nurses in the region were collected,and the equity of the two dimensions of resident population and geographical area was evaluated by us-ing the curve and Gini coefficient.Results In 2016,the Gini coefficient of resource allocation of health institutions in Zhangjiakou was 0.19,which was in a highly fair state.The Gini coefficient of bed resource allocation in health insti-tutions was 0.28,which was fairer.Gini coefficient of 1000 nurses was 0.43,which was unfair.The Gini coefficient of health resources according to population allocation was 0.43 for registered nurses,0.34 for doctors,0.34 for health technicians,0.28 for beds and 0.19 for health institutions,the allocation of nurses resources was slightly unfair.The average number of medical institutions was 1.04 per 1000 square kilometers,and the Gini coefficient of bed resource allocation was 0.55,which was very unfair;the average number of health technicians was 4.03 per 1000 square kilometers,and the Gini coefficient of professional technicians was 0.61,which was highly unfair.The average number of doctors per thousand square kilometers was 1.49,and the Gini coefficient of doctors per thousand square kilometers was 0.56,which was very unfair.The average number of nurses per thousand square kilometers was 0.12,and the Gini coefficient of nurses per thousand square kilometers was 0.63,which was highly unfair.Except for health institutions the allocation of resources was very unfair.From 2013 to 2016,the Gini coefficient of health re-sources allocated by population in Zhangjiakou area did not change much.Except for the Gini coefficient of medical and health institutions fluctuated greatly in 2015 and decreased to the previous level in the next year,the Gini coeffi-cient showed a declining trend.The Gini coefficient of doctors according to population distribution showed a slightly higher increase trend,the average Gini coefficient of doctors according to population distribution was 0.27,which was fairer.Gini coefficient of health resources allocated by region was 0.53,showed a very unfair trend.Gini coefficient of nurses decreased significantly compared with 2016,and that of health technicians decreased suddenly in 2014,and in-creased steadily to the previous level in the next year.The Gini coefficient of health institutions was basically stable,and the Gini coefficient of beds increased slightly.Therefore,the Gini coefficient of health resources allocated by pop-ulation was better than that allocated by region.Conclusion In recent years,the distribution of medical and health re-sources in Zhangjiakou has been unfair,the proportion of medical and health care is unbalanced,and the resources are significantly concentrated and unreasonable.