河南省不同经济水平地区医养结合试点机构资源配置研究

Resource allocation in pilot institutions of integrated medical and elderly care services with medical care in different economic level areas in Henan province

目的:了解河南省不同经济水平地区医养结合试点机构资源配置现状,为政府合理配置资源提供参考。方法:采用普查方法,于2019年1月-7月对河南省17个省辖市全部医养结合试点机构进行问卷调查,按人均国内生产总值(GDP)聚类划分为3类地区,采用统计描述、χ2检验和秩和检验对河南省医养结合试点机构的规模、服务提供和工作人员情况的地区差异进行比较。结果:高、中、低经济水平地区每个医养结合试点机构的建筑面积中位数分别为11 583.38 m2、6 283.30 m2、6 000.00 m2,三者比较差异具有统计学意义(P<0.05);平均入住率分别为19.57%、31.29%、41.99%;医护比分别为2.07:1,1.88:1,1.05:1,中等发达地区、欠发达地区拥有硕士及以上学历、高级职称的护理人员不足5%;调查涉及的8类18项卫生服务项目中,生活照顾服务等9项比较差异具有统计学意义(P<0.05)。结论:河南省不同经济水平地区医养结合试点机构规模不同、入住率偏低;服务提供方面存在差异;人员结构不合理、高级护理人才不足。建议政府积极发挥引导作用,促进各地医养结合机构的均衡发展。

Objective:To understand the status quo of resource allocation in pilot institutions of integrated medical and elderly care services with medical care in areas with different economic levels in Henan province. To provide references for the government to allocate resources rationally. Methods:The general investigation was used in this study. Among all pilot institutions of integrated medical and elderly care services with medical care in 17 province-administered cities in Henan province,a questionnaire survey was conducted from January to July2019. All the institutions were divided into 3 types of regions according to the real gross domestic product(GDP)per capita. Statistical description,chi square test,and rank-sum test were used to compare the regional differences in the scale,service provision,and staff status of the pilot institutions of integrated medical and elderly care services with medical care in Henan province. Results:The median building areas of each pilot institution of integrated medical and elderly care services with medical care at high,medium,and low economic levels were11 583. 38 m2、6 283. 30 m2、6 000. 00 m2,respectively. The difference was statistically significant(P<0. 05). The average occupancy rates were 19. 57%,31. 29%,and 41. 99%,respectively;the doctor-nurse ratio were 2. 07∶1,1. 88∶1,and 1. 05∶1,respectively. There were less than 5% of nurses with master’s degree or above and senior professional titles in moderately developed areas and underdeveloped areas.Among the 18 health service items in 8 categories involved in the survey,there were 9 items,such as living care service,which had statistically significant differences(P<0. 05). Conclusions:The pilot institutions of integrated medical and elderly care services with medical care in areas with different economic levels in Henan province were different in scales,with low occupancy rate. There was difference in service provision.The staff structure was unreasonable,and the number of senior nursing talents was insufficient. It is recommended that the government should play an active guiding role to promote the balanced development of institutions of integrated medical and elderly care services with medical care in various regions.