河北省医疗卫生服务机构资源配置现状分析与对策研究

发布时间：2018-05-06 04:08

本文选题：卫生机构 + 资源配置　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:本文通过对河北省医疗卫生服务机构资源配置现状进行描述和统计分析,探索本省居民医疗卫生服务需求的发生发展规律,发现我省医疗卫生服务机构资源配置存在的问题并找出原因,根据未来五年的社会经济发展和医疗卫生服务需求,提出河北省“十三五”医疗卫生服务机构规划建议,为政府制定“十三五”规划提供参考。方法:1文献研究。利用中国学术期刊网(CNKI)、万方数据库、维普数据等途径收集国内外有关的区域卫生规划制定方法和有效性评价的文献,归纳总结,形成综述,作为本课题的研究思路。全面解析我国的医疗改革方针政策,对规划的背景有所了解,参考全国“十三五”规划编制原则和要求,在对资源配置进行全面了解的同时为我省“十三五”规划提出政策建议。2数据整理分析。采用描述性统计的方法,分析研究河北省各市的医疗卫生服务机构资源配置现状,其中包括医疗卫生机构配置现状、卫生人力资源配置现状、床位配置现状、医疗机构设备配置现状、卫生经费、居民健康状况等,对搜集的数据进行整理分析,现有资料进行现状描述,发现问题,提出政策建议。3专家咨询。为制定最佳的研究设计方案,探索河北省医疗卫生服务机构资源配置现状存在的主要问题,得出较为有意义的统计结果,邀请河北省内医院管理、社会医学与卫生事业管理、卫生经济领域等的专家,进行分组讨论研究。4公平性统计分析。洛伦兹(Lorenz)曲线的纵轴为不同地区拥有卫生资源数量构成的百分比,并按其大小进行排序,其横轴为对应地区的人口累计百分比,将每个点连接,绘制成洛伦兹曲线。45度对角线作为参考线,也叫做公平线。如果卫生资源配置比较接近于公平,曲线就越靠近公平线(45度对角线);反之,就远离公平线。以绝对公平线与洛伦兹曲线围成的面积为分子,绝对公平线下直角三角形面积为分母,其比值称作基尼系数。基尼系数取值介于0到1之间,各个地区资源分布越公平,基尼系数越接近0;反之,基尼系数越接近1。各个地区资源绝对平均,基尼系数小于0.2;资源分布比较平均,基尼系数大于0.2小于0.3;资源分布基本合理,基尼系数大于0.3小于0.4;资源分布差距较大,基尼系数大于0.4小于0.5;资源分布差距悬殊,基尼系数为0.5;资源分布处于高度不公平的危险状态,基尼系数则大于0.6。国际上将0.4作为“警戒线”。所有数据均采用spss13.0和excel2007进行统计分析。结果:1河北省由11个地级市构成,总面积约18.88万平方公里,有7383.75万常住人口,城市人口占49.33%,农村人口占50.67%,男女比例1.03:1,常住人口中有677.09万人为65岁以上老年人口,占总人口的9.17%;有1314.30万人为14岁以下儿童,占17.80%;22014年河北省生产总值达到29421.15亿元,2013年为28442.95亿元。2014年人均gdp为39984元;城市居民人均可支配收入24141.34,农村居民为10186.14,城镇居民家庭恩格尔系数为26.17%,农村居民家庭达29.36%;3我省共有78906个医疗卫生机构,其中医院1341个,综合医院894个,基层医疗卫生机构75624个,其中包括卫生院1960,社区卫生服务中心1169,专业公共卫生机构1667。我省综合医院数量最多达894个,中医院、专科医院数量较少。从医疗机构的比例可以看出,基层医疗机构的比例最大,占医疗机构总量的94.6%,其次是公共卫生机构,中医院所占比例最小,仅占0.2%;4河北省所有医疗卫生服务机构共有床位数322909张,其中医院有236889张,基层医疗卫生机构73108张,专业公共卫生机构11907张,各地区床位数分布如table5,床位数最多集中在石家庄,邯郸、保定,秦皇岛衡水医疗机构床位数分布较少。河北省共有医师数157725人,石家庄拥有的医师数最多,达到49496人,张家口医师数最少仅7352人,千人口执业医师数石家庄秦皇岛较高,具体详见table6,石家庄的护士数最多,达22773人;5河北省医疗卫生资源配置数量,如床位数、执业医师数和注册护士数与人口数显著相关,可以根据拟合出的公式,预测未来五年人口数变化从而预测相应的床位数、执业医师数、注册护士数的配置数量;6河北省十一个市医疗卫生机构床位数、执业医师数和护士数配置公平性按照常驻人口进行配置时基尼系数分别为0.1462、0.1132、0.1346,均小于0.2,公平性较好。结论:仅从人口需求和地域分布来看,河北省的医疗卫生服务资源能够适应居民医疗健康的基本需求,医疗卫生资源分布比较均衡,公平性较好。医疗卫生资源的数量与人口数有一定的线性关系,受人口策略因素影响较大,未来在优化卫生资源配置时考虑人口数量变化以及人口策略影响,医疗卫生服务机构设置应该随着计划生育政策的变化和人口老龄化发展作适度调整和增量,还应考虑社会经济、财政投入、医疗卫生政策变革等因素,以确保规划实施。
[Abstract]:Objective: through the description and statistical analysis of the resources allocation status of medical and health service institutions in Hebei Province, this paper explores the law of the development of the medical and health service requirements of the residents in this province, and finds out the existing problems in the allocation of medical and health service institutions in our province and finds out the reasons, according to the social and economic development and medical health in the next five years. In order to provide a proposal for the planning of the "13th Five-Year" medical and health service organization in Hebei Province, this paper provides a reference for the government to formulate the "13th Five-Year" plan. Method: 1 literature research. Using the Chinese Academic Journal Network (CNKI), the Wanfang database, and VP data to collect the articles on the formulation and effectiveness evaluation of regional health planning at home and abroad. A comprehensive analysis of China's medical reform policy, understanding of the planning background, the national "13th Five-Year" planning principles and requirements, a comprehensive understanding of the allocation of resources, and a policy suggestion for the "13th Five-Year" plan of the province, as well as the policy recommendations for the "13th Five-Year".2. A descriptive statistics method was used to analyze the status of the resources allocation of medical and health service institutions in Hebei Province, including the status of medical and health institutions, the status of health human resources allocation, the status of bed configuration, the status of medical facilities, health funds, health status of residents and so on. In order to make the best research design scheme and explore the main problems existing in the status quo of the resources allocation in Hebei medical and health service institutions, we can draw up more meaningful statistical results and invite the hospital management in Hebei Province, social medicine and health affairs in Hebei province. The experts in the industry management, the health economy field, etc., carry out group discussion and study the.4 fairness statistical analysis. The longitudinal axis of the Lorenz (Lorenz) curve is the percentage of the number of health resources in different regions and is sorted according to their size. The horizontal axis is the percentage of the population involved in the corresponding area, and each point is connected to a Lorenz curve. .45 diagonal as a reference line, also called a fair line. If the allocation of health resources is closer to fairness, the curve is closer to the fair line (45 degree diagonal); conversely, it is far away from the fair line. The area enclosed by the absolute fair line and the Lorenz curve is a molecule, the area under the absolute equitable line is the denominator, and the ratio is called Gini. Coefficient. Gini coefficient is between 0 and 1. The more equitable distribution of resources in each region, the more the Gini coefficient is closer to 0; conversely, the Gini coefficient is closer to 1. areas, the Gini coefficient is less than 0.2, the distribution of resources is more than 0.2 less than 0.3, the resource distribution is reasonable, the Gini coefficient is greater than 0.3 less than 0.4. The source distribution gap is large, the Gini coefficient is more than 0.4 less than 0.5, the resource distribution gap is very wide, the Gini coefficient is 0.5, the resource distribution is in the high unfair risk state, the Gini coefficient is larger than 0.6. international general 0.4 as the "warning line". All data are statistically analyzed using SPSS13.0 and Excel2007. Results: 1 Hebei province is from 11 prefecture level. The city is composed of about 188 thousand and 800 square kilometers with a total area of 73 million 837 thousand and 500 residents, 49.33% of the urban population, 50.67% for the rural population, 50.67% in the rural population, 1.03:1 for men and women, 6 million 770 thousand and 900 in the permanent population, accounting for 9.17% of the total population, and 13 million 143 thousand for 14 years old, and 17.80% of the population. The total GDP of Hebei Province in 22014 has reached 29421.1. 500 million yuan per capita in 2013 was 2 trillion and 844 billion 295 million yuan.2014 per capita of 39984 yuan; the per capita disposable income of urban residents was 24141.34, rural residents were 10186.14, urban residents' family Engel coefficient was 26.17%, rural households were 29.36%; 3 our province had 78906 medical institutions, 1341 hospitals of traditional Chinese medicine, 894 in comprehensive hospitals, and grass-roots medical machines. 75624, including health centers 1960, community health service center 1169, professional public health institutions 1667., the number of comprehensive hospitals in our province is up to 894, the number of traditional Chinese medicine hospitals and specialist hospitals is small. The proportion of traditional Chinese medicine hospital is the smallest, accounting for only 0.2%. 4 Hebei province all medical and health service institutions have 322909 beds, of which there are 236889 hospitals, 73108 medical and health institutions, 11907 professional public health institutions, and the distribution of beds in each area, such as table5, the bed number is most concentrated in Shijiazhuang, Handan, Baoding, Qinhuangdao Hengshui medical treatment. The number of institutional beds is less. There are 157725 doctors in Hebei province. The number of doctors in Shijiazhuang is the most, the number of doctors in Shijiazhuang is the most, the number of Zhangjiakou doctors is only 7352, the number of practitioners in Shijiazhuang Qinhuangdao is higher, the specific details are table6, and the number of nurses in Shijiazhuang is up to 22773; 5 Hebei Province medical and health resources allocation number, such as The number of practitioners and the number of registered nurses are significantly related to the number of population. According to the formula, we can predict the number of changes in the number of people in the next five years, the number of licensed physicians, the number of registered nurses, and the number of vitality beds in eleven cities in Hebei Province, the number of practicing physicians and the fair number of nurses. The Gini coefficient of sex according to the resident population is 0.1462,0.1132,0.1346, both are less than 0.2, and the fairness is better. Conclusion: from the point of view of population demand and regional distribution, Hebei medical and health service resources can adapt to the basic needs of residents' medical health, the distribution of medical health resources is relatively balanced and fair. There is a certain linear relationship between the number of raw resources and the number of population, which is greatly influenced by the population strategy factors. In the future, the change of population and the influence of population strategy should be taken into consideration in optimizing the allocation of health resources. The establishment of medical and health service institutions should be adjusted and incrementally adjusted with the change of family planning policy and the development of the population aging. Consider social economic, financial input, health care policy changes and other factors to ensure the implementation of the plan.

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

【参考文献】