中国全科医生配置公平性研究

Equity of General Practitioner Distribution in China

背景当今社会面临人口老龄化、慢性病高发等问题,实施全科医生制度是保障和维护居民健康的重要途径。足够数量的全科医生是居民获得全科服务的必要条件。近年来全科医生数量有长足的发展,但是其在不同经济发展水平地区分布情况存在差异,了解各经济发展水平地区全科医生的情况,并引导各个地区合理配置全科医生是实现全民健康的重要环节。目的分析中国全科医生在不同经济发展水平地区分布情况及变化趋势。方法根据2013-2018年中华人民共和国国家数据网站中各地区生产总值,将中国大陆地区31个省(自治区、直辖市)分为5个不同的经济水平组,结合2013-2017年中国卫生与计划生育统计年鉴及2018年中国卫生健康统计年鉴中各地区全科医生数量,对各组全科医生的分布情况进行描述性分析,利用集中指数分析历年公平性变化趋势,并通过泰尔指数分解配置总体差异。结果2012-2017年,中国全科医生数量从10.98万人增至25.27万人,增幅为130.15%。最高经济水平组的每万人口全科医生数量均明显高于其他各经济水平组,2017年达到每万人口3.61人。同期,全科医生集中指数先下降后上升,2015年最低(0.1921)。分解的泰尔指数贡献率显示,不同经济水平组间历年差异贡献率均超过70%。结论中国全科医生数量明显增加,经济发展水平较高地区的全科医生数量及注册为全科医学专业的医生比例均较高;全科医生在不同经济发展水平地区的分布公平性差,且差异主要源于不同经济水平组之间。

Background Nowadays,the society is faced with problems such as aging population and high incidence of chronic diseases.The implementation of general practitioner(GP)system is an important way to guarantee and maintain residents'health.A sufficient number of GPs is a necessary condition for residents to obtain the services from GPs.The GP system has made great progress in recent years,but the distribution of GPs is different in areas with different economic development levels.It is an important part of achieving universal health to understand the situation of GPs in areas with different economic development levels and guide the reasonable allocation of GPs in each area.Objective To analyze the distribution of GPs and its change trends in regions with different economic development levels in China.Methods Using the data of the National data website of the People's Republic of China from 2013 to 2018,31 provinces(autonomous regions and municipalities)in China were divided into five different economic level groups according to the per capita GDP.Combined with the number of GPs in different regions in China Health and Family Planning Statistical Yearbook 2013—2017 and China Health and Wellbeing Statistical Yearbook 2018,a descriptive analysis was made on the distribution of the GPs in each group.The concentration index was used to analyze the trend of fairness changes,and the overall difference in distribution was configured through the Theil index.Results From 2012 to 2017,the number of GPs in China increased from 0.1098 million to 0.2527 million with an increase of 130.15%.The number of GPs per 10000 population in the highest economic level group was significantly larger than the other economic level groups,reaching 3.61 per 10000 population in 2017.During the same period,the GP concentration index declined first and then rose,reaching the lowest level in 2015(0.1921).According to the decomposition of Theil index contribution rate,the annual difference rate between different economic level groups contributed more than 70%.Conclusion The number of GPs in China has increased significantly.The number of GPs and the proportion of GPs registering in general practice as specialty are both relatively great in areas with high economic development level.The distribution fairness of GPs is poor in regions with different economic development levels,and the difference between groups with different economic levels is the main source of the unfair distribution of GPs.