宁夏卫生资源配置公平性研究

发布时间：2018-03-04 16:14

本文选题：卫生资源　切入点：公平性　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:2009年新医改以来,我国政府对卫生事业的关注度不断提高,建立起了较为健全的基本医疗保障体系,国家投入大量资金发展医疗卫生事业。然而,时至今日群众“看病难、看病贵”的问题并未得到明显改善,广大人民群众日益增长的医疗卫生需求同有限的医疗卫生资源之间的矛盾依然突出,卫生资源配置的公平性和合理性是我国卫生事业发展和改革必须解决的重点问题和亟待研究的重要课题。目的:本文收集全国和宁夏卫生统计年鉴、卫生事业发展公报等资料中宁夏卫生资源配置量情况,结合社会经济与卫生事业发展状况,运用经济学评价方法深入分析宁夏卫生人力、物力和财力资源配置的现状和公平程度,试图通过宁夏卫生资源配置中存在的主要问题,为新医改提出一些合理化建议,供政府决策部门参考。方法:本文采用描述性分析法对宁夏卫生资源配置现状进行分析,运用Lorenz曲线、基尼系数和泰尔指数,对2009-2015年宁夏卫生人力、物力和财力三大资源的人口和地理配置的公平性进行分析,利用层次分析法确定各卫生资源指标对总指标体系的权重,并结合Topsis法对5个地市的卫生资源配置进行综合评价.结果:1.卫生人力资源方面:6年间,卫生人员总量持续稳增,卫生人员增加了15813人,卫生人员增量主要集中在卫技人员。卫生人力资源人口配置基尼系数均在0.40以下,且呈下降趋势,人口配置公平性较好;地理配置基尼系数均在0.40以上,且呈上升趋势,地理配置公平性差;尤其是注册护士和管理人员配置公平性较差。卫生人力资源地市内差异的对总差异的贡献率均在51.00%以上,高于地市间差异的贡献率。2.卫生物力资源方面:各类卫生机构和床位总量均呈上升趋势,截止2015年,全区共有各类医疗机构4289家,床位数33804张。医疗机构和床位人口配置基尼系数均低于0.20,地理配置公平性均低于0.40,卫生物力资源人口配置公平性优于地理配置。宁夏物力资源的区内差异对总体差异的贡献率均在62.00%以上,明显大于区间差异对总体差异的贡献率。3.卫生财力资源:2009-2015年,宁夏卫生总费用占GDP比重从6.32%增加至7.89%,逐年稳步增加;政府卫生预算支出增长速度高于GDP增长速度,均明显高于全国平均水平。卫生财政补助人口配置基尼系数均低于0.20,人口配置绝对公平;地理配置基尼系数均低于0.40,人口配置公平性优于地理配置。4.综合评价:2015年宁夏5个地市卫生资源配置于最优方案的接近程度在0.1582-0.6904之间,各地市之间的资源配置差异较大;经Topsis法排序,卫生资源配置最“差”的是中卫市,C值为0.1582;最“好”的是银川市,C值为0.6904。6年来,除银川市和石嘴山市外,吴忠市、固原市和中卫市卫生资源配置的C值均有所上升。结论:2009-2015年,宁夏卫生资源总量逐年递增,且人均卫生资源拥有量总体上高于国家平均水平,但存在地区差异,注册护士和管理人员总量相对较少。基于基尼系数分析的宁夏卫生人力、物力和财力资源配置总体处于公平状态且逐渐提高,三种卫生资源按人口配置公平性均优于按地理配置。基于泰尔指数分析的宁夏卫生人力、物力和财力资源配置总体处于公平状态,且三种资源配置的公平性均受区域内资源配置的影响较大。基于层次分析法的卫生资源权重排序从高到低依次为卫生人力、财力和物力资源。基于Topsis法的宁夏卫生资源配置综合排序从高到低依次为银川市、石嘴山市、固原市、吴忠市和中卫市。建议:1.科学制定区域卫生规划,促进卫生资源的优化整合。2.加大财政投入,完善基层医疗卫生服务体系建设。3.多措并举,建立卫生人力资源发展长效机制。4.以实际需要为导向,改善卫生资源配置公平性。5.以病人实际需求为导向,合理配置卫生人才资源。6.以艰边地区为重点,推进全区卫生事业协同发展
[Abstract]:Background: in 2009 since the new medical reform, the Chinese government in the health sector increasing attention to establish a basic medical insurance system more perfect, the state invested heavily in the development of medical and health services. However, today the "difficult and expensive" problem has not been significantly improved, the contradiction between the masses is the growth of medical and health needs with limited health resources is still outstanding, health resource allocation fairness and rationality is an important subject of key issues and reform of the health development of our country must solve urgently and research. Objective: this collection of national and Ningxia Health Statistics Yearbook, Ningxia health resources allocation health development bulletin the data in the situation, combined with the status of social economic development and health, using the economic evaluation method in-depth analysis of Ningxia health manpower, material resources and The status quo and fairness of the allocation of financial resources, attempts through the main problems existing in Ningxia in the allocation of health resources, and puts forward some reasonable suggestions for the new health care reform, for government decision-making departments for reference. Methods: This paper adopts descriptive analysis method to analyze the current situation of the health resources in Ningxia, using the Lorenz curve, Gini coefficient and Theil index of 2009-2015 years of health manpower in Ningxia, analyze the fairness of population and geographic configuration of the three material and financial resources, using the AHP to determine the weight of each index of total health resources index system, combined with Topsis method, comprehensive evaluation of health resource allocation in 5 cities. Results: 1. health human resources 6 years, the total health personnel and health personnel continued steady growth, an increase of 15813, mainly concentrated in the incremental health personnel of health technical personnel. Health human resource allocation Gini coefficient of population The number is below 0.40, and the downward trend of the equitable allocation of population geographic configuration is better; the Gini coefficient was above 0.40, and the upward trend, the geographical configuration fairness; especially the registered nurse staffing and management of poor fairness. The city differences in health human resources of the total difference contribution rate more than 51%, higher than the difference between the contribution rate of.2. health material resources: the total amount of various health institutions and beds showed an upward trend, as of 2015, there were altogether 4289 types of medical institutions, 33804 beds. The beds of medical institutions and the population allocation Gini coefficient was lower than 0.20, fairness was lower than that of geography 0.40, physical health fair population resources allocation is better than the geographic allocation. Ningxia resources in the region difference of the difference of the overall contribution rate was more than 62%, significantly higher than the interval difference to overall difference contribution Contribution rate of.3. health financial resources: 2009-2015 years, Ningxia total health expenditure accounted for the proportion of GDP increased from 6.32% to 7.89%, the growth rate increased steadily year by year; the health budget government spending is higher than the GDP growth rate, were significantly higher than the national average. Health subsidies population distribution Gini coefficient was lower than 0.20, the absolute population allocation fairness; geographic configuration Gini the coefficient is less than 0.40, fair allocation is better than that of the population geographic configuration.4. comprehensive evaluation: 2015 5 cities of Ningxia health resource allocation scheme in proximity to the optimal allocation of resources between 0.1582-0.6904, the difference between the larger around the city; by the method of Topsis scheduling, allocation of health resources in the "poor" is a central defender, C value 0.1582; the "good" is the city of Yinchuan, the C value is 0.6904.6 years, in addition to Yinchuan city and Shizuishan City, Wuzhong City, distribution of health resources in Guyuan city and the city centre are on the C value L. Conclusion: 2009-2015 years, the amount of health resources in Ningxia is increasing year by year, and the per capita health resources generally higher than the national average level, but the regional difference, the total amount of registered nurses and managers is relatively small. The Gini coefficient of Ningxia based on the analysis of health manpower, material and financial resources in the overall state fair and gradually increased. Three according to the equitable allocation of health resources are better than the population according to the geographical configuration. The Theil index analysis of Ningxia health based on human, material and financial resources allocation in the overall state fair, and three kinds of fair resource allocation are affected by the allocation of resources within the region greatly. Health resources AHP based sorting from high to low for health manpower, financial and material resources. Based on the Topsis method of Ningxia health resource allocation ranking from high to low are Yinchuan City, Shizuishan city, Guyuan City, Wuzhong City and city centre. 1. suggestions: establishing regional health planning, optimization and integration of.2. to promote health resources to increase financial investment, improve the construction of basic medical and health service system.3. Duocuobingju, establish health human resources development mechanism.4. to actual needs as the guidance, improve the equity of health resources allocation to.5. patient demand oriented, rational allocation of health human resources in.6. difficult boundary areas, promote the region's health coordinated development

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1

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