上海市老年人社区卫生资源配置公平性研究

Equity of community health resource allocation for the elderly in Shanghai

目的分析上海市老年人社区卫生资源配置的公平性。方法将上海市各行政区划分为中心城区、城郊区、浦东新区以及崇明区四个区域板块,以上海市116所社区卫生服务中心为研究对象,基于社区卫生人力资源和财政投入,采用基尼系数和泰尔指数,从服务人口和地理维度分析上海市社区卫生资源配置的公平性。结果上海市社区在岗卫生技术人员和总财政补偿基于服务老年人口维度的基尼系数为0.116和0.251,基于地理维度的基尼系数为0.483和0.329。泰尔指数分析结果与基尼系数基本一致,卫生人力资源配置公平性略优于财政投入,卫生资源配置人口公平性优于地理公平性,区域之间差异是基于地理因素的老年人社区卫生资源配置公平性差异的主要因素(71.47%~86.71%),区域内部差异是基于老年人口的社区卫生资源配置公平性差异的主要来源(52.52%~89.44%)。结论上海市老年人社区卫生资源配置结构总体较为公平,但是人口公平与地理公平、区域板块之间与区域板块内部的差异仍不可忽视。

Objective To analyze the equity of community health resource allocation available to the elderly in Shanghai to provide a reference for the optimization of their allocation and to ensure the basic medical needs of the elderly.Methods 116 community health service centers were selected as research objects.Based on the human resources and financial inputs for community health,the Gini coefficient and Theil index were used to analyze the equity of community health resource allocation in Shanghai from the service population and across geographical dimensions.Results The Gini coefficients of in-service health technicians and total financial compensation,as based upon the dimension of serving the elderly population,were 0.116 and 0.251,respectively,while the Gini coefficients based on the geographical dimension were 0.483 and 0.329(respectively).The results of the Theil index analysis are relatively consistent with the Gini coefficient.The equity of health human resource allocation is slightly better than that of financial investment,and the equity of health resource allocation population is better than that concerning geography.Regional differences are the main factors regarding the equity of health resource allocation of the elderly community based on geographical factors(71.47%-86.71%),intra-regional differences were the main source of equity differences in community health resources allocation based on the elderly population(52.52%-89.44%).Conclusion The allocation structure of community health resources for the elderly in Shanghai is,on the whole,fair;but,the differences between population equity and geographical equity,and between and within regional plates,cannot be ignored.