基于基尼系数的棘球蚴病防治卫生人力资源配置公平性分析

Analysis of the equity of health human resource allocation for echinococcosis control based on Gini index

目的分析四川省甘孜藏族自治州棘球蚴病防治卫生人力资源配置现状并评价其公平性,为优化棘球蚴病防治卫生人力资源配置提供实证依据。方法2020年,采用问卷调查收集2016—2019年四川省甘孜藏族自治州2个棘球蚴病重度流行县和3个轻度流行县每1000名常住人口、每1000 m^(2)面积、采用B超每筛查1000人、每1000例棘球蚴病患者拥有的卫生人力资源(包括卫生人员、卫生技术人员、执业/助理医师和注册护士)数量,并运用洛伦兹曲线、基尼系数对2016—2019年甘孜藏族自治州棘球蚴病防治卫生人力资源按常住人口和地理面积配置的公平性进行评价。结果2019年,四川省甘孜藏族自治州棘球蚴病轻度流行县每1000名常住人口拥有的卫生人员、卫生技术人员、执业/助理医师和注册护士数量分别是重度流行县的0.99、1.06、1.78、1.88倍,每1000 m^(2)面积拥有的卫生人员、卫生技术人员、执业/助理医师和注册护士数量分别是重度流行县的3.38、3.67、6.00、6.00倍,采用B超每筛查1000人拥有的卫生人员、卫生技术人员、执业/助理医师和注册护士数量分别是重度流行县的1.64、1.74、3.22、3.18倍,每1000例棘球蚴病患者拥有的卫生人员、卫生技术人员、执业/助理医师和注册护士数量分别是重度流行县的64.92、70.39、139.34、117.44倍。2016—2019年,甘孜藏族自治州棘球蚴病防治卫生人力资源按常住人口计算的基尼系数为0.371~0.397、按地理面积计算的基尼系数为0.477~0.591;2019年,执业/助理医师和注册护士按常住人口和地理面积计算的基尼系数(0.469~0.730)均高于卫生人员和卫生技术人员(0.302~0.451)。结论2016—2019年,四川省甘孜藏族自治州棘球蚴病防治卫生人力资源按常住人口配置的公平性一般、按地理面积配置的公平性较差。

Objective To analyze the current status and evaluate the equity of health human resource allocation for echino⁃coccosis control in Ganzi Tibetan Autonomous Prefecture,Sichuan Province,so as to provide the empirical evidence for optimiz⁃ing the health human resource allocation for echinococcosis control.Methods A questionnaire survey was performed to collect the numbers of health human sources for echinococcosis control,including health workers,healthcare professionals,certified/as⁃sistant physicians and registered nurses,per 1000 permanent residents,per 1000 m^(2),per 1000 residents screened using B⁃mode ultrasonography and per 1000 echinococcosis patients in two highly endemic counties and three lowly endemic counties in Ganzi Tibetan Autonomous Prefecture,Sichuan Province from 2016 to 2019.The equity of health human resource allocation for echinococcosis control was evaluated by permanent residents and geographical areas using Lorenz curve and Gini index in Ganzi Tibetan Autonomous Prefecture from 2016 to 2019.Results The numbers of health workers,healthcare professionals,certified/assistant physicians and registered nurses per 1000 permanent residents,per 1000 permanent residents,per 1000 m^(2),per 1000 residents screened using B⁃mode ultrasonography and per 1000 echinococcosis patients were 0.99⁃,1.06⁃,1.78⁃and 1.88⁃fold;3.38⁃,3.67⁃,6.00⁃and 6.00⁃fold;1.64⁃,1.74⁃,3.22⁃and 3.18⁃fold;and 64.92⁃,70.39⁃,139.34⁃and 117.44⁃fold more in lowly en⁃demic counties than in highly endemic countries in Ganzi Tibetan Autonomous Prefecture,Sichuan Province,2019.The Gini in⁃dexes of health human resource allocation for echinococcosis control were 0.371 to 0.397 by permanent residents and 0.477 to 0.591 by geographical areas in Ganzi Tibetan Autonomous Prefecture from 2016 to 2019,and the Gini indexes(0.469 to 0.730)for allocation of certified/assistant physicians and registered nurses were both higher than those of health workers and healthcare professionals(0.302 to 0.451)by both permanent residents and geographical areas.Conclusion The health human resource al⁃location for echinococcosis control showed general equity by permanent residents and poor equity by geographical areas in Ganzi Tibetan Autonomous Prefecture,Sichuan Province from 2016 to 2019.