1995~2018年上海市医疗卫生资源配置公平性及变化趋势分析

Analysis of fairness and trends in the allocation of medical and health resources in Shanghai from 1995 to 2018

目的评价1995~2018年上海医疗卫生资源配置公平性和变化趋势。方法基于基尼系数和泰尔指数,从"人口公平性"与"地理公平性"的综合视角对上海市1995~2018年医疗卫生资源配置的公平性进行全面评价,并运用Mann-Kendall非参数检验预测其变化趋势。结果 1995~2018年上海市医疗卫生资源按人口分布的基尼系数为0.225 9~0.411 9,配置处于正常状态或最佳状态,呈上升趋势;按地理面积分布的基尼系数为0.892 4~0.979 3,处于危险状态,呈下降态势;总体泰尔指数为0.010 9~0.058 1,配置较为公平,但呈下降趋势。此外,基尼系数和泰尔指数均显示,公平性改善主要受卫生机构和床位数的影响,卫生机构对公平性的贡献最大,而卫生技术人员配置的悬殊是公平性下降的主要原因;卫生机构和床位数的配置不公平主要来源于地区内,而卫生技术人员的配置不公平主要来源于地区间。结论上海市医疗卫生资源配置较公平且近年来公平性呈上升趋势。但现阶段仍存在按人口配置公平和按地理面积配置不公平的矛盾,未来存在按人口配置趋向不公平和按地理面积配置趋向公平的矛盾。优化卫生技术人员配置是提高未来医疗卫生服务公平性的关键,解决地区间配置差异是优化卫生技术人员配置的有效途径。

Objective To evaluate the equity of health care resource allocation in Shanghai and the changing trends from 1995 to 2018. Methods Being based on the Gini coefficient and the Theil index, the equity of health care resource allocation in Shanghai from 1995 to 2018 was comprehensively evaluated from the perspective of "demographic equity" and "geographic equity", and the Mann-Kendall non-parametric test was used to predict the trends of changes.Results The Gini coefficient of the distribution of medical and health resources by population in Shanghai from 1995 to2018 was 0.225 9 to 0.411 9, and the configuration was in a normal or optimal state with an increasing trend. The Gini coefficient distributed by geographic area was 0.892 4 to 0.979 3, which was in a disadvantaged state and a decreasing trend. The overall Theil index ranged from 0.010 9 to 0.058 1, which was a more equitable configuration, but with a decreasing trend. In addition, both the Gini coefficient and the Theil index showed that equity improvements were mainly influenced by the number of health facilities and beds, with health facilities contributing the most to equity, while the disparity in health technician staffs was the main reason for the decline in equity. Inequities in the allocation of health facilities and the number of beds originated mainly within regions, while inequities in the allocation of health technicians originated mainly between regions. Conclusions The allocation of health care resources in Shanghai is more equitable and the equity has been on the rise in recent years. However, at the present stage, there is still a contradiction between equitable allocation by population and inequitable allocation by geographic area, and in the future, there is a contradiction between the tendency of inequitable allocation by population and the tendency of equitable allocation by geographic area. Optimizing the allocation of health technicians is the key to improving equity, and addressing regional differences in allocation is an effective way to optimize the allocation of health technicians.