撤乡并镇背景下四川省基层医疗卫生资源可及性变化研究

Researches on the Changes in Accessibility of Primary Healthcare Resources in Sichuan Province under the Background of Township Merger Policy

目的:分析四川省撤乡并镇前后基层医疗卫生资源可及性变化及其影响因素,为行政区划改革后基层医疗卫生资源的有效整合配置提供理论依据。方法:收集2016、2019、2021年四川省乡镇层面基层医疗卫生资源、人口、行政区划相关数据,利用ArcGIS软件计算基层医疗卫生资源供需比和最短就医距离,比较其在撤乡并镇前后差异,利用多元线性回归模型探究人口、城乡、民族、人均国内生产总值、行政区划面积等因素的影响。结果:撤乡并镇后,四川省乡镇层面人均医疗卫生资源数量和最短就医距离均有所增加;人口稠密、经济发达、城市、非民族地区人均资源数量更充足;人口稀疏、农村、少数民族地区最短就医距离更长;城市和非少数民族地区基层医疗资源空间可及性更优,撤乡并镇使得中心城市地区和边远农村地区之间的差异扩大。结论:撤乡并镇后基层医疗卫生服务保障整体提升但居民获取医疗卫生服务的不公平程度增大,尤其是人口分布稀疏的边远农村和少数民族地区。在行政区划改革后半段工作中,应结合人口、城乡、民族、经济、行政区划面积等因素,合理规划资源空间分布和配置,提高可及性和公平性。

Objective To analyze the changes in accessibility of primary healthcare resources before and after the township merger in Sichuan Province and its influencing factors,and provide theoretical support for the effective integration and allocation of primary healthcare resources afer the administrative division reforms.Methods Data related to primary healthcare resources,population,and administrative divisions at the township level in Sichuan Province for the years 2016,2019 and 2021 were collected.ArcGIS software was used to calculate the supply-demand ratio of primary healthcare resources and the shortest distance to medical services.The differences before and after the merger were compared.And a multiple linear regression model was utilized to explore the impact of factors such as population,urban-rural divide,ethnicity,per capita GDP and administrative division area.Results After the township merger,the per capita quantity of primary healthcare resources and the shortest distance to medical services increased at the township level in Sichuan Province.Areas with dense population,developed economics,urban settings,and non-ethnic minority regions had more sufficient per capita resource quantity.Sparse population areas,rural areas and ethnic minority regions had longer distances to medical services.Urban and non-ethnic minority regions had better spatial accessibility to primary healthcare resources,and the merger of townships and towns widened the disparities between central urban areas and remote rural areas.Conclusion The overall provision of primary healthcare services improved after the township merger,but the degree of inequality in accessing healthcare services for residents increased,especially in sparsely populated remote rural and ethnic minority areas.In the later stage of administrative division reform,it is necessary to consider factors such as population,urban-rural divide,ethnicity,economy and administrative division area,in order to plan the spatial distribution and allocation of resources rationally,and improve its accessibility and equity.