健康公平导向的基层卫生服务设施空间规划策略研究

Health Equity Orientated Spatial Allocation Strategies for Community Healthcare Services:A Review

本文尝试探索以健康公平为导向的基层卫生服务设施的空间规划策略。公平性是一个多元概念,在哲学、政治学、法学、经济学和社会学等不同的学科语境下,它具备不同的内涵。对个体而言,健康公平关乎一个人获得其他生活资源的能力;对社会而言,健康公平不仅决定着一个社会是否正义,也决定了一个社会需要多少福利进行再分配。目前,各国医疗卫生资源分配的原则,被归纳为主要基于平等主义、优先主义和充足主义三种理论,深刻地影响着各国在卫生资源福利分配政策、卫生资源重点投向、医疗保险等方面的宏观体制设计。在编制规划时,需要充分理解我国社会资源分配的基本原则和医疗卫生资源分配的顶层设计。同时,健康服务横跨了地理和空间环境、卫生科学和经济学等不同学科领域,各级设施的空间规划需由卫生规划和城市规划部门共同完成,而各学科对公平性的概念的定义和评价方法不尽相同。因此,在制定卫生服务设施的空间规划策略时,需要厘清卫生规划和城市规划对于公平性评价的异同,选择适合的评价体系和工具。本文因而主要分两个部分:首先,通过分别对地理和空间环境与卫生科学两个领域的相关文献进行综述,厘清公平性的概念和评价方法;然后,针对医疗卫生设施的规划,归纳两个学科领域实现公平时各自的侧重点和方法,找出不同因素之间的关联,并在此基础上提出实现健康公平的设施规划策略。策略的第一步是根据我国基本公共卫生服务均等化的原则,在每个城乡社区都规划设置基层卫生服务站点,以提高卫生设施的整体可达性。然而,正如卫生资源的社会供给并不等同于个体的健康获得,基层卫生服务设施的可达也不同于健康服务的可及。实现对医疗卫生设施和资源公平分配,并不等于就实现了健康公平。因此,策略的第二步是在地方行政层级的卫生服务设计上,基于平等主义原则,对研究区医疗卫生服务供需的现状进行调查和描述,通过公平的资金筹措,对现有的医疗资源进行更加公平的分配。在设施可达性差的区域,适当增加基层设施的服务内容并提高服务质量,以提升这些设施的服务能力和利用效率,并最终提高研究区健康服务的整体可及性,提升城乡设施居民的服务利用率,满足他们的健康服务需要,向实现全民健康公平的目标迈进。

This paper explores the health equity-oriented spatial planning strategies for primary health service facilities.Health equity,however,has many aspects,and is best seen as a multidimensional concept.It has different connotations in different disciplines such as philosophy,political science,law,economics,and sociology.To individuals,it affect ones’capability to obtain resources for living.To a society,it is not only the indicator for social justice,but also the major factor decides the total amount of social welfare needed for redistribution.At present,the major principles used in medical resources allocation in all countries are the application of three theories:Egalitarianism,Prioritarianism and Sufficientarianism,which profoundly affects each country’s macro structure of social warfare in terms of healthcare and health insurance policies.As a medical planning aims to materialize the prime principles of social resource allocation and the overarching design of health resource allocation,understanding those principles in China is crucial.Furthermore,health service cross over different disciplines such as geographic and spatial environment,medical science and economics.In China,the spatial planning of medical facilities at all levels needs the co-operations of health and urban planning authorities,to whom the definitions and evaluation methods of equity are different.Therefore,when developing spatial planning strategies for health services,it is necessary to clarify the similarities and differences between health planning and urban planning for equity evaluation and to select suitable evaluation systems and tools.This paper has two major parts:First,review literatures in both geographical and spatial environment and health science to clarify the EFJ concepts and evaluation methods.Second,finds out the relationship between those concepts and methods to develop the spatial planning strategies for prime medical facilities.Firstly,set up one primary healthcare service station in every urban and rural community,in accordance with the current Outline of the National Health Service System(2015-2020)to improve the overall accessibility.Nevertheless,as the capability to achieve good health does not necessarily lead to the achievement of health,the accessibility of health care facilities does not mean the accessibility of the services.The second step of the strategy is thus to investigate and visualize the current situation of the supply and demand of health services in research areas and,enrich services and/or improve quality of primary facilities in areas with healthcare shortage.As such,the overall accessibility of services increased with the utilization rate of urban and rural residents,whose needs are fulfilled towards the health equity for all.