基于集聚度的河北省乡村卫生资源配置公平性分析

Analysis for the fairness in health resources allocation based on agglomeration degree in rural area in Hebei

目的基于集聚度的概念对河北省11市乡村卫生资源配置公平性进行分析,为政府部门在医药卫生体制改革、推进“健康中国”等工作中制定卫生资源配置政策提供科学合理的依据。方法利用“河北省卫生统计信息网络直报系统”的数据,计算卫生资源集聚度(HRAD)和卫生资源集聚度与人口集聚度之比(HRAD/PAD),分析河北省11市乡村卫生资源配置公平性。结果2019年河北省各市乡村卫生资源集聚度差异较大(HRAD范围:0.2025~2.8671),承德和张家口各项指标的聚居度基本<0.5,而邯郸、石家庄、唐山、邢台、廊坊的集聚度绝大多数≥1.2。按人口配置的乡村卫生资源也存在差别(HRAD/PAD范围:0.4638~2.1528):承德HRAD/PAD均>1.4;村卫生室数量的HRAD/PAD石家庄仅为0.4638,而衡水为1.5398;村卫生室和乡镇卫生院注册护士的HRAD/PAD廊坊约为0.7,而秦皇岛村卫生室和唐山乡镇卫生院注册护士的HRAD/PAD则在1.4左右。结论河北省乡村医疗卫生服务存在资源配置不公平的现象,按人口资源配置公平性优于按地理面积配置。在今后的乡村卫生资源配置中要考虑区域人口密集程度,兼顾卫生资源空间布局。

Objective To analyze the fairness in health resources allocation based on agglomeration degree in rural area in 11 cities of Hebei province,so as to provide a scientific and reasonable basis for government departments to perform medical science system reform.Methods Using the data from“Hebei Province Health Statistics Information Network Direct Reporting System”to calculate the health resource agglomeration degree(HRAD)and the ratio of health resource agglomeration degree to population agglomeration degree(HRAD/PAD),so as to analyze the fairness of rural health resources in 11 cities in Hebei.Results In 2019,the agglomeration degree of rural health resources varied considerably in different cities(HRAD range:0.2025~2.8671).The various indicators of agglomeration degree in Chengde and Zhangjiakou were below 0.5,however,the agglomeration degree in Handan,Shijiazhuang,Tangshan,Xingtai,and Langfang was more than 1.2.There were differences in rural health resources allocated by population(HRAD/PAD range:0.4638~2.1528),and the HRAD/PAD indicators in Chengde were higher than 1.4,and the HRAD/PAD of the number of village clinics in Shijiazhuang was only 0.4638,which in Hengshui was 1.5398.In addition the HRAD/PAD of registered nurses in village clinics and township health centers in Langfang was about 0.7,however,which in Qinhuangdao and Tangshan was above 1.4.Conclusion There exists inequitable status in the health resources allocation in rural area in Hebei,and the fairness of resource allocation based on population is superior to that based on geographic area.In the future,it is necessary to consider the degree of regional population density and take into account the spatial distribution of health resources.