Health Disparities among the Western, Central and Eastern Rural Regions of China after a Decade of Health Promotion and Disease Prevention Programming

Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differ- ences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate （IMR）, mater- nal mortality rate （MMR） and under 5 mortality rate （U5MR） had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR （65.05%）; whereas, western rural China had the greatest reduction in MMR （72.99%） but smallest reduction in U5MR （57.36%）. Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators （odds ratios）： IMR （central： 2.13; western： 5.31）, U5MR （central： 2.25; western： 5.69）, MMR （central： 1.94; western： 3.31）, and prevalence of infectious diseases （central： 1.62; western： 3.58）. The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health dis- parities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.

Regional Differences in Specific Health Examination Utilization and Medical Care Expenditures in Japan

Background: Despite having one of the most successful health systems in the world, annual medical expenditures in Japan have been increasing year to year. We sought to clarify regional differences in medical expenditures by analyzing the relationship between the specific health examination coverage and medical care expenditure by prefecture of Japan. Methods: We used data from the National Database of Health Insurance Claims and Specific Health Checkups (NDB) Open Data Japan (2015) and Overview of 2015 National Medical Expenses to compare medical care expenditure per capita and proportions of persons receiving specific health examination between Japan nationally and individual prefectures. Results: National medical expenditures were 42.3 trillion Japanese yen (JPY) (3851 hundred million dollars), with a national per capita rate of JPY347,219 (USD3156). Per capita medical expenditure rates by prefecture ranged from JPY290,900 (USD2645) in Saitama Prefecture to JPY 444,000 (USD4036) in Kochi Prefecture. The proportion of persons receiving specific health examinations was 49.0% for Japan overall and ranged from 39.3% in Hokkaido Prefecture to 63.4% in Tokyo Prefecture. We observed a significant negative correlation between per capita medical expenditures and the proportion of persons receiving specific health examinations (R = 0.553, p < 0.001). Conclusion: We found a significant negative correlation between per capita medical expenditures and the proportion of persons receiving health examinations: prefectures with lower expenditures tended to have higher rates of medical examinations. Interventions to increase the proportion of persons receiving specific health examinations by prefecture could reduce per capita medical expenditures and reduce prefectural disparities in expenditures.

Environmental Infrasound and Its Impact on Public Health in the Kashmir Region

In earlier published studies it was shown that an anomalous degree of human physiological ailments and a psychology of sustained anger and violence exist in highly populated countries located on boundaries of colliding Tectonic Plates in three continents at Latitude 34&#176 north. The Valley of Kashmir in Northern India is also located exactly on this latitude, hence chosen for detailed experimental verification of this phenomenon. This region also suffers from chronic public health hazards. Infrasound is very low frequency acoustic wave with frequencies ranging from 0.01 Hz to 20 Hz. It emanates from earthquakes, geological Faults, colliding tectonic plates and atmospheric wind turbulence. Hearing protections like ear muffs and ear plugs offer little protection. One single earthquake can cause multiple infrasound sources in a region. It is shown how regional geomorphology in the Kashmir Valley enhances and sustains this phenomenon. Both the percentage of population with hearing disabilities;and casualties due to social violence increase or decrease in proportion to frequency of earthquakes. Infrasound is shown to be the causal linkage. Public health hazards due to environmental infrasound closely resemble public health hazards actually being suffered by the population in Kashmir as established by formal and extensive medical investigations. Hence a Field Study was carried out to locate and record infrasound emissions in ten locations near 34&#176N latitude in Kashmir Valley. An analytical technique was developed to integrate infrasound spectrum in specific locations with public health hazards. It was discovered that infrasound recorded in South Kashmir around 34&#176N latitude at the locations of highest amplitude lies in proximity of Active Faults from earthquake ruptures;and in proximity to a large field of past earthquakes that took place in 2006-2012. A comprehensive public health security system needs to be set up very urgently. Technological measures are identified and appropriate technologies suggested cordoning off and mitigating this natural environmental hazard in the Kashmir Valley.

智慧化区域健康管理服务体系设计与构建

目的 探索构建覆盖漷县地区全人群、全生命周期、全病程的智慧化区域健康管理服务体系。方法 搭建以北京大学人民医院通州院区为核心的健联体,采集并整合漷县地区居民健康档案、就诊记录、居家自我健康监测等多模态健康医疗数据,建立区域健康管理智能数据平台及重点专科专病数据库。结果 构建数据驱动的智慧化区域健康管理服务体系实现了急诊急救、慢病管理、康复服务、智能养老、健康教育、公共卫生监测与预警等功能,形成全方位的区域健康管理闭环。结论 区域健康管理智能数据平台的建立为一体化、延续性的健康管理提供全生命周期、全病程的数据支撑;在此基础上构建的智慧化区域健康管理服务体系,能够满足全区域、全人口的健康管理与疾病防治需求,全方位提升以通州院区为核心的漷县地区居民健康保障能力。

突发公共卫生事件对区域经济韧性的影响机制与应对:来自中国新冠病毒感染疫情的证据

产业结构服务业化会对区域经济抵抗力产生不利影响,但可以提升区域经济恢复力。产业多样化有利于提升区域经济的抵抗力和恢复力,而专业化则容易产生相反的结果。突发公共卫生事件对区域经济韧性的影响首先表现在对服务业冲击上,并随时间发展传导至制造业,韧性的恢复也是首先由服务业开始的。由此,提出相关政策建议。

Evaluation of Milk Compositional Quality and Mammary Gland Health of Dairy Herds in the Southwestern Brazilian Amazon

Samples of raw milk from bulk cooling tanks were collected in five municipalities of the Southwestern Brazilian Amazon to establish the prevalence of Staphylococcus aueus and Streptococcus agalactiae, as well as to evaluate the milk composition and its correlation with the bulk tank somatic cell count (BTSCC). A total of 250 samples were collected to investigate the causal agents of bovine mastitis in whole milk, from 50 bulk milk tanks in each municipality. Under laboratory conditions, the samples were diluted to 1/10 and 1/100, and samples of 0.1 ml from each dilution were plated in triplicate on selective media for Staphylococcus aureus and Streptococcus agalactiae. To evaluate the correlation between the major milk components (fat, protein and lactose) and the BTSCC, samples were collected for 18 months from 73 dairy herds. The presence of the above-mentioned contagious mastitis pathogens was detected in 97.2% (243/250) of refrigerated raw milk samples evaluated. Analysis of the major milk components and BTSCC demonstrated that during the study period, fat compo-nent showed the largest variance, followed by protein and lactose, which also showed significant variances.

康养产业与区域经济深度融合:困境、动力机制与现实路径

康养产业作为一项新兴业态,产业链涵盖旅游、医疗、养老等诸多产业。推动其与区域经济深度融合是在新发展阶段下我国实施积极应对老龄化战略、健康中国战略、乡村振兴战略的重要内容,是实现共同富裕目标的必然举措。本文探寻康养产业与区域经济深度融合的理论逻辑,结合康养产业的特征和类型,剖析康养产业与区域经济融合发展存在的问题。并从外部、内部两个维度分析康养产业与区域经济深度融合的动力机制,认为外部动力机制有政策驱动、需求拉动以及市场拓展;内部动力机制有企业竞争、技术变革以及思想转变。可以通过政府提供政策支持与保障,建立康养发展水平评价机制,培养融合型康养人才,推动康养产业智慧化发展,健全康养产业发展体系等方面,实现康养产业与区域经济的有效融合,助力共同富裕。

基于区域卫生信息平台的深圳市盐田区带状疱疹流行特征分析及预测

目的探索带状疱疹(herpes zoster,HZ)的流行特征,开展短期预测,为HZ防制提供依据。方法基于深圳市盐田区区域卫生信息平台,回顾性调查盐田区2019—2023年HZ发病情况,对基本流行特征进行描述性分析,Joinpoint回归模型分析发病率变化趋势,GM(1,1)模型对发病率进行短期预测。结果2019—2023年深圳市盐田区共诊断5888例HZ病例,发病率呈逐年上升趋势,年均发病率5.85‰。0~<50岁年龄组病例占比(52.55%)高于≥50岁(47.45%),但发病率≥50岁(17.01‰)高于0~<50岁(3.67‰),女性发病率(6.15‰)高于男性(5.73‰)。50~<80岁各年龄组发病率逐年呈上升趋势(P<0.001)。带状疱疹后神经痛(post-herpetic neuralgia,PHN)发生率15.23%。GM(1,1)模型拟合精度等级为好,预测显示,2024—2026年HZ发病率呈上升趋势。结论HZ是值得关注的公共卫生问题,病例构成以0~<50岁居多,但≥50岁发病率高且呈明显上升趋势。GM(1,1)模型可用于HZ的发病预测,对HZ的流行趋势分析具有一定的指导意义。

内蒙古自治区医疗卫生资源公平性研究

医疗卫生资源的优化配置是涉及民生的重要问题,作为卫生服务的重要基础,不仅影响卫生服务的质量,而且影响人民群众的健康水平。内蒙古自治区地形复杂多样,各盟市的经济发展水平也存在差异,医疗卫生资源配置出现了不同的层次。根据地理位置,将内蒙古自治区各盟市分为内蒙古东部地区、内蒙古中部地区、内蒙古西部地区,选取内蒙古自治区医疗卫生人力资源和物力资源方面的指标,利用泰尔指数(Theil Index)实证分析2012年至2021年内蒙古自治区的医疗卫生人力资源和物力资源配置。结果显示,内蒙古东部地区、内蒙古中部地区、内蒙古西部地区医疗卫生人力资源和物力资源的泰尔指数虽然呈现下降趋势,但是地区之间的医疗卫生资源配置仍然存在不公平现象。基于此,提出持续优化医疗卫生资源区域布局、做好中蒙医药资源的开发和利用、推进人才队伍建设等建议。

文旅融合背景下安康地域文化传承创新研究

“旅游是文化的重要载体和平台,文化乃旅游之灵魂。”丰富多样的地域文化是旅游文化的重要组成部分之一。为更好地彰显“以文兴旅、以旅彰文”理念,该文以安康地域文化的传承为研究内容,采用文献查阅法、调查研究法,系统梳理了安康地域文化的独特魅力,归纳总结了安康地域文化的内涵,认识到文旅融合背景下传承创新安康地域文化乃塑造旅游文化的灵魂,并提出从“生态+文旅”“毛绒玩具+文旅”“非遗+文旅”“美食+文旅”等模式多层面提升安康文旅品牌效应,传承创新地域文化,深化文旅融合发展,为经济社会发展赋能,推动文化繁荣、坚定文化自信。

Productivity change of national health systems in the WHO Eastern Mediterranean region:application of DEA-based Malmquist productivity index

Background:The pursuit of efficiency and productivity is one of the goals of health systems.In the era of Sustainable Development Goals and particularly the move towards universal health coverage,it is imperative to curb wastage of resources to ensure sustainable access of the population to needed and effective health services without enduring financial hardship.This study aims to assess total factor productivity change of national health systems of 20 countries in the WHO’s Eastern Mediterranean Region.Methods:Data Envelopment Analysis(DEA)-based Malmquist index is used to assess total factor productivity change and its components-efficiency change and technical change.To assess the robustness of the Malmquist index estimates,bootstrapping was performed.Outputs used are life expectancy at birth for both sexes and infant mortality;while total expenditure on health per capita in international dollars(PPP)is used as a measure of input.Panel data for the period 2003-2014 was extracted from databases of the WHO and the World Bank.Results:In all but five countries covered in the study,a decline in the mean total factor productivity is observed during the period 2003-2014.The decline is driven by technical regress.In all countries,the technical change component of the Malmquist TFP index is less than unity(range:0.896 to 0.945).All countries exhibited growth in efficiency(efficiency change exceeding one)except two countries(Djibouti and Iraq).The growth in efficiency was mainly due to change in scale efficiency.Overall,total factor productivity in the region declined by 3.8%.This was due to a 9.1%decline in technical change,which overshadowed the 5.8%increase in efficiency.Three countries-Libya,Qatar and Yemen-showed a marginal growth in total factor productivity.There was no change in total factor productivity in Kuwait and Lebanon.Conclusion:The decline in total factor productivity over the study period is likely to hamper achieving the targets of Sustainable Development Goal 3 of ensuring healthy lives and promoting well-being for all at all ages.It is recommended that country-level studies on efficiency and productivity of health systems be conducted in order to intensively examine the determinants of inefficiency and productivity decline and implement appropriate interventions that could enhance efficiency and productivity.

基于熵权TOPSIS法和RSR法的四川省卫生资源配置地区差异性研究

[目的]分析四川省卫生资源配置的地区差异性,为促进四川省卫生资源协同发展提供参考。[方法]采用熵权TOPSIS法和RSR法综合评价2017-2021年四川各州(市)卫生资源的配置情况。[结果]四川省每千人口床位数、卫生技术人员、执业(助理)医师和注册护士从2017年的6.787张、6.395人、2.356人和2.754人增长到了2021年的7.908张、8.035人、2.991人和3.663人。根据熵权TOPSIS法计算,2017-2021年成都市、攀枝花市、广元市和雅安市的C值较大,排序均在前5位以内;广安市、达州市、甘孜州和凉山州的C值较小,排序均排在后5位以内。按照RSR进行分档,差的档次为甘孜州、凉山州和广安市,好的档次为广元市、雅安市、攀枝花市和成都市,其余14个州(市)为中的档次。[结论]四川省各州(市)卫生资源配置差异性较为明显,四川省卫生资源配置分档结果优质资源相对不足,应逐步缩小卫生资源配置的地区差异,促进卫生资源的协同发展。

长三角地区中医药卫生资源配置现状及运行效率分析

目的分析长三角地区中医药卫生资源配置现状和运行效率变化情况。方法采用描述性统计方法对2012—2021年长三角地区中医药卫生资源的配置现状进行分析,采用三阶段数据包络分析模型静态分析中医药卫生资源运行效率,采用Malmquist指数模型动态分析中医药卫生资源运行效率。结果长三角地区中医药卫生资源相对丰富,经过三阶段数据包络分析,江苏、浙江的综合效率、纯技术效率和规模效率基本均被低估;上海的纯技术效率、规模效率和综合效率基本均被高估;安徽的纯技术效率、规模效率和综合效率在2012—2016年被高估,2017—2021年被低估。经过Malmquist指数模型动态分析,2012—2021年长三角地区中医药卫生资源的全要素生产率指数在1.000上下波动,均值为0.984,运行效率呈下降趋势。结论长三角地区中医药卫生资源配置不均衡,利用差异化,效率不稳定。建议政府和卫生健康行政主管部门因地制宜,合理规划区域卫生,加强技术创新,提高医疗技术水平,提高中医药卫生资源配置运行效率。

2009—2018年广西公立医疗机构放射作业人员职业健康检查结果分析

目的分析2009—2018年广西壮族自治区(以下简称广西)公立医疗机构放射作业人员职业健康检查情况,为制订相应的职业健康管理措施及职业健康防护提供依据。方法收集2009—2018年9259名广西公立医疗机构放射作业人员的职业健康检查结果,比较不同性别、年龄、工龄、工种的放射作业人员各项体检结果情况。结果广西公立医疗机构放射作业人员职业健康检查中腹部B超异常、晶状体混浊、尿常规异常发生率较高;男性放射作业人员的血压异常率、肝功能异常率、腹部B超异常率、肾功能异常率高于女性,血常规异常率、尿常规异常率、甲状腺异常率低于女性(P<0.05);不同年龄放射作业人员的血压异常率、晶状体混浊率、染色体畸变率、肝功能异常率、腹部B超异常率、肾功能异常率差异有统计学意义(P<0.05),不同工龄放射作业人员的血压异常率、晶状体混浊、染色体畸变率、肝功能异常率、腹部B超异常率、尿常规异常率、肾功能异常率、甲状腺异常率差异有统计学意义(P<0.05),其中,血压异常率、晶状体混浊率、腹部B超异常率随着年龄、工龄的增加而增加;不同工种放射作业人员晶状体混浊率、腹部B超异常率、尿常规异常率、甲状腺异常率差异有统计学意义(P<0.05)。结论广西地区公立医疗机构放射作业人员健康检查结果中男性多项指标的异常率高于女性,血压异常率、晶状体混浊率、腹部B超异常率随着年龄、工龄的增加而呈上升趋势。相关部门应对不同工种人员进行有针对性的防护意识培训及作业风险评估,切实保护放射工作人员的职业健康。

中医医院卫生技术人员配置水平空间差异及分布动态

目的:分析中医医院卫生技术人员配置的空间差异和分布动态演进,为制定中医医院卫生技术人员优化配置策略提供参考。方法:构建2012-2021年30个省份的中医医院卫生技术人员的面板数据,采用Dagum基尼系数和核密度估计探究中医医院卫生技术人员的空间差异及分布动态演进过程。结果:2012-2021年中医医院卫生技术人员配置水平存在空间差异,差异整体呈缩小态势。东部区域中医医院卫生技术人员的配置水平最高,增速最慢、区域内差异最大;中部区域的增速较慢、配置水平较低、区域内差异最小;西部区域增速最快、配置水平最低、区域内差异较大。东部与西部的区域间差异最大,东部与中部的区域间差异最小。总体差异的主要来源是超变密度。结论:中医医院卫生技术人员配置水平的总体差异在缩小,其非均衡性有所减弱,为此,建议完善体制机制,统筹区域协调发展,激活政策存量并兼顾政策创新。

区域慢性病智能健康管理平台设计与实现

目的/意义落实糖尿病、高血压等慢性病综合防控策略,推动医疗、公共卫生融合的居民健康管理。方法/过程以打通业务联动和数据融合为基础,设计构建区域化慢性病智能健康管理平台,建立患者全息健康档案,采集日常监测数据,实现建档、诊疗、随访、饮食/运动管理、风险评估、智慧宣教等系统功能。结果/结论平台使用初期为数千例糖尿病与高血压患者提供区域内一体化健康管理服务,实现慢性病患者健康信息全面掌控与监测,逐步构建居民健康全流程闭环管理模式。

民族地区农村老年人健康素养现状及影响因素研究

目的分析雅安市民族地区农村老年人健康素养现状及影响因素,为制定老年人群健康素养提升策略提供参考。方法2023年7月17—20日采用连续抽样法,对四川省雅安市汉源县所属4所乡镇卫生院367名60岁及以上农村老年人进行一般资料、健康素养与健康教育需求问卷调查。结果民族地区农村老年人健康素养得分率为35.80%。基本认知、慢性病防治、传染病防治、饮食健康4方面健康素养得分率分别为:19.67%、41.31%、21.21%、60.60%;健康教育总需求得分为(17.59±5.44)分,各条目平均得分为(3.52±1.09)分;多重线性回归分析显示:居住情况及文化程度是健康素养的影响因素(P<0.05);Pearson相关性分析结果显示:健康素养与健康教育需求呈正相关(P<0.05)。结论雅安市民族地区农村老年人健康素养水平较低,健康教育需求较大,农村老年人的健康素养受文化程度、居住情况等因素影响。应从老年人的实际需求出发,针对不同特征的老年人制定健康教育方案,以提升民族地区农村老年人健康素养水平。

我国中老年人群慢性病患病率及患病种类区域差异与医疗卫生资源的相关性研究

背景中国正逐渐步入老龄化社会,中老年人的健康问题越来越受到关注,其中高血压、糖尿病、冠心病、脑卒中等慢性病成为主要的健康威胁。同时,医疗卫生资源分布不均,导致地区间的医疗水平和服务质量存在差异。目的探讨我国中老年人群慢性病患病率、患病种类区域差异与医疗卫生资源的相关性。方法2022年10月—2023年3月研究者通过对中国健康与养老追踪调查2018年(CHARLS)数据进行清洗、整理及统计分析,共纳入19520名≥45岁的中老年人,并选取《中国卫生统计年鉴》(2011—2020年)中的2018年统计数据作为对应的医疗卫生资源相关数据。采用多元线性回归分析的方法将各省份的床位数、卫生技术人员数[执业(助理)医师、注册护士、乡村医生和卫生员]、财政支出(卫生健康总支出)、卫生机构数(医院、基层医疗卫生机构、专业公共卫生机构)的泰尔指数与各省份中老年人慢性病患病率进行相关性分析。结果东、中、西部地区中老年人慢性病患病率(χ^(2)=57.900,P<0.001)、患慢性病数量(χ^(2)=11.138,P=0.004)比较,差异有统计学意义;东、中、西部慢性地区中老年人在14种慢性病患病类型中,慢性肺部疾病(χ^(2)=30.906,P<0.001)、肝脏疾病(χ^(2)=17.871,P<0.001)、脑血管疾病(χ^(2)=18.313,P<0.001)、肾脏疾病(χ^(2)=24.383,P<0.001)、消化系统疾病(χ^(2)=16.973,P<0.001)、记忆相关疾病(χ^(2)=6.898,P=0.032)、哮喘(χ^(2)=22.055,P<0.001)的患病率比较,差异有统计学意义;多元线性回归分析结果显示,中老年人慢性病总体患病状况与医院、基层医疗机构、执业(助理)医师、注册护士、乡村医生和卫生财政支出的公平性有关(P<0.05)。结论我国东、中、西部中老年人群慢性病患病率存在区域差异,不同地区对卫生事业的投入及医疗卫生资源配置也存在一定差异。应加强重大慢性病的区域性健康管理,提高基层防病治病和健康管理能力,壮大医疗卫生人员队伍,改善医疗卫生资源区域配置公平性,从而缩短东、中、西部中老年人慢性病患病的区域差异。

不同地区护理人员对脑卒中高危气象因素及其管理的认知和体验

目的:通过不同地区护理人员对脑卒中高危气象因素的认知和体验,探究基于气象的影响因素及应对策略,为形成规范的基于气象的脑卒中高危人群预防管理方案提供借鉴。方法:2023年2月—4月,采用目的抽样法选取兰州市、西安市、沈阳市、锦州市、长春市、南京市、苏州市、广州市、东莞市9个城市三级甲等医院的15名护理人员,采用质性研究的主题分析法进行深度访谈,采用Colaizzi 7步法分析访谈资料。结果:共提炼了两大主题:气象因素对脑卒中发病影响的认知和体验(气温对脑卒中发病影响的认知、季节对脑卒中发病影响的体验、气压对脑卒中发病影响的认知、湿度对脑卒中发病影响的认知);基于气象因素对脑卒中发病的管理策略(居家生活相关的管理策略、家庭支持相关的管理策略、信息支持相关的管理策略、健康教育相关的管理策略、用药指导相关的管理策略)。结论:气象因素与脑卒中关系密切,气象因素改变会导致机体出现微妙的变化进而诱发脑卒中。预防脑卒中的发病,应注意脑卒中发病与气象因素的关系,根据气象因素对脑卒中高危人群进行健康管理。

中国西部地区全科医生资源配置公平性分析及需求预测研究

背景全科医生是居民健康的守门人,其资源的合理配置是实现卫生服务公平性的基本保障。目前我国对全科医生配置方面的研究主要集中于全国和部分单体省份,缺乏针对以西部地区为研究对象的全科医生人力资源配置的研究。目的评价2015—2020年我国西部地区全科医生资源配置现状,为西部地区优化全科医生资源配置提供参考。方法本研究数据来源于2016—2017年《中国卫生和计划生育统计年鉴》、2018—2022年《中国卫生健康统计年鉴》、2016—2022年《中国统计年鉴》。运用阿特金森指数和区位熵对西部地区全科医生配置进行总体测算和具体分解;运用灰色预测模型对西部地区2022—2025年全科医生需求量进行预测。结果2015—2020年西部地区全科医生数从39290人增加至94652人,年均增长率为19.23%;2015年和2020年按人口、经济和地理面积分布的阿特金森指数分别是0.1265和0.0493、0.1244和0.0382、0.7865和0.6944;2020年西部各省份的人口、经济、地理指标的区位熵分别在0.7943~1.2190、0.6970~1.3373、0.0432~7.7270,西南地区地理配置区位熵>1,西北地区人口配置区位熵优于地理配置,甘肃省、青海省和广西壮族自治区经济指标的区位熵在研究年限内均>1;灰色模型预测2022—2025年西部地区全科医生数量呈增长趋势。结论西部地区全科医生资源配置水平逐渐提升,结构逐步优化,但仍存在总量不足、分布不均、注册率较低、公平性较差等问题。建议应以地理分级为标准,以“调增优存”为原则,以职业吸引力为目标,以资源整合和区域协同为导向,进一步优化西部地区全科医生资源配置。