中国与日本山区城乡医疗服务公平性与效率性对比研究

Comparison on Fairness and Efficiency of Urban-rural Medical Service in the Mountain between China and Japan

山区医疗服务设施建设是城乡等值化发展的难点,中国和日本分别采取了两种不同的发展策略。通过梳理中日两国平衡城乡医疗服务差异的政策举措,并运用两步移动搜索法与核密度估算法,测算公共服务空间可达性构建公平性模型,利用皮尔森相关分析衡量服务效率,进一步对位于山区的中国德化县和日本庄原市的医疗服务公平性和效率性进行比较。结果表明:德化县人口和医疗资源呈现城关地区“一区独大”的空间布局,庄原市则呈现都市区域连通辐射周边的空间格局;德化县医疗服务存在城乡不公平现状,城关地区供需关系相对平衡,但非城关区域不平衡;庄原市在大部分地区保证良好的公平性,整体医疗服务效率高于德化县,在都市(城镇)区域德化县表现为高效性,在农村区域表现为低效性。研究认为,追求效率优先是德化县兼顾公平的保证,效率和公平的统一需要以雄厚的工业基础和财政支出作支撑。

The construction of medical service facilities in mountainous areas is a difficult point in the development of urban and rural equivalence.China and Japan adopt two different development strategies respectively.This article summarizes policy measures to balance urban and rural medical services in China and Japan,using the research method of two-step floating catchment area method and nuclear density estimation,this paper builds a fairness model by measuring the spatial accessibility of public services,and uses Pearson correlation analysis to measure service efficiency.Calculate and compare the fairness and efficiency of medical services in Dehua County,China and Zhuangyuan City,Japan,located in mountainous areas.The results show that:(1)While the population and medical resources in the central cities of Dehua County outshine other areas,that in Zhuangyuan City form connection structure of radiation.(2)A serious urban-rural inequality of medical opportunity happens in Dehua county,the demand-supply equilibrium of medical services was in central cities but in other regions;while good fairness of the services was improved in the most areas of Zhuangyuan City.(3)On the whole region,the medical service efficiency of Zhuangyuan City is higher than that of Dehua County,in which high efficient services were provided in urban regions but low in rural regions.The study suggests that prioritizing efficiency is an assurance of fairness for Dehua County,and the unity of efficiency and fairness requires strong industrial foundations and financial support.