2009年至2018年医院与基层医疗机构发展情况对比分析

Comparative analysis of the development of hospitals and primary healthcare institutions from 2009 to 2018

目的对比分析2009年新医改以来医院和基层医疗机构的发展情况。方法基于2009年至2018年的官方统计数据和定性资料,计算医院和基层医疗机构人才、设施设备、收入支出和服务提供数量的年均增长率等指标,并以医院作为对照,分析基层医疗机构的发展变化情况。结果2009年至2018年医院卫生技术人员数量年均增速(7.49%)高于基层医疗机构(4.32%),医院和基层医疗机构卫生技术人员总量差值逐年增大。医院基础设施建设增速更快。基层医疗机构的财政补助收入增速快于医院,但因为基数低,基层医疗机构财政补助收入的绝对数小于医院。医院的总收入和医疗收入增速快于基层医疗机构。医院的服务量增速快于基层医疗机构,尤其是住院服务。医院的病床使用率保持在84%以上水平,而基层医疗机构仅60%左右。结论医院的快速扩张产生了巨大的虹吸作用,抑制了基层医疗机构的发展。医疗资源错配难以通过医保等措施扭转。实现资源的合理配置是实现分级诊疗的前提。

Objective To comparatively analyze the development of hospitals and primary healthcare institutions during the healthcare reform since 2009.Methods Based on statistical data from 2009 to 2018 and qualitative data,the development of primary healthcare institutions and hospitals was compared from 2009 to 2018 by computing the compound annual growth rate of health manpower,facilities,income,expenditure and service.Results The growing speed of health professionals in hospitals(7.49%)was much faster than primary healthcare institutions(4.32%).The difference of healthcare professionals in hospitals and primary healthcare institutions grew larger and larger.The infrastructure in hospitals had developed much faster compared to that of primary healthcare institutions.The growing speed of fiscal subsidy in primary health care institutions was much faster.However the absolute number of fiscal subsidy for primary health care institutions was smaller than hospitals.The average growing speed of total income and medical income in hospitals was much faster.The average growing speed of health service in primary healthcare institutions was much slower,especially the inpatient service.The rates of hospital beds use in hospitals and primary health institutions were about 84%and 60%respectively.Conclusions The quick expansion of hospitals was siphoning resources and curbing the development of primary healthcare institutions.Healthcare resources mismatch could hardly be overturned by measures taken in medical insurance.Rational health resources distribution was essential for hierarchical medical system to develop.