我国优质医疗资源配置公平性的区域差异及时空演进研究

Regional differences and spatiotemporal evolution of equity in the distribution of high-quality medical resources in China

目的:分析2017-2021年优质医疗配置公平性的区域差异以及时空演进情况,为促进优质医疗资源合理配置提供借鉴。方法:采用卫生资源集聚度测算优质医疗资源配置公平性,使用Dagum基尼系数分析优质医疗资源配置的区域差异,综合运用核密度估计法和莫兰指数研究优质医疗资源在时间和空间上的动态演进过程。结果:2017-2021年优质医疗资源集聚度的全国均值分别为3.936、3.779、3.651、3.464、3.539,区域差异分析表明组内差异、组间差异和超变密度对总差异的贡献率均值分别为24.953%、73.860%、1.186%。其中组内差异中最大的是东部地区,组间差异对优质医疗资源公平性差异的影响最高,超变密度最小代表3个区域交叉重叠的影响甚微;时间演进分布表明东部地区中各省间优质医疗资源配置公平性差异在缩小,但呈现多极化分布,而中部和西部地区中各省间差异有不同程度的扩大;空间自相关分析表明优质医疗资源配置公平性在整体空间上呈现空间正相关关系,而且聚集现象呈提升趋势。结论:优质医疗资源配置公平性的绝对差异缩小,优质医疗资源配置公平性存在区域差异,组间差异是影响优质医疗资源公平性的关键要素,各地区优质医疗资源公平性处于动态变化并呈现空间聚集特征。

Objective:To analyze the regional differences and spatiotemporal evolution in the equity of high-quality medical resource allocation from 2017 to 2021,providing insights to support the rational allocation of such resources.Methods:The concentration degree of health resources was used to measure the equity of high-quality medical resource allocation,with Dagum’s Gini coefficient applied to analyze regional differences.Kernel density estimation and Moran’s Index were used to study the dynamic evolution of high-quality medical resources over time and space.Results:The national average concentration degrees of high-quality medical resources from 2017 to 2021 were 3.936,3.779,3.651,3.464,and 3.539,respectively.Analysis of regional differences showed that the average contributions of intragroup differences,intergroup differences,and hypervariable density to total difference were 24.953%,73.860%,and 1.186%,respectively.The eastern region showed the largest intragroup difference,while intergroup differences had the greatest impact on the equity of high-quality medical resources,with minimal hypervariable density indicating a minor impact from regional overlap.Temporal evolution indicated a narrowing gap in equity within eastern provinces,though showing a multi-polarized distribution,while differences within central and western provinces expanded to varying degrees.Spatial autocorrelation analysis revealed a positive spatial correlation in the equity of high-quality medical resource distribution,with an increasing trend of resource clustering.Conclusion:Absolute differences in the equity of high-quality medical resource distribution have narrowed,yet regional disparities remain.Intergroup differences are a critical factor influencing equity,with each region showing dynamic changes and spatial clustering in the equity of high-quality medical resource allocation.