深圳市综合医院空间公平性测度及评价研究

发布时间：2018-01-08 06:28

本文关键词：深圳市综合医院空间公平性测度及评价研究　出处：《深圳大学》2017年硕士论文　论文类型：学位论文

【摘要】：在我国高速城镇化进程中,如何高效、公平的利用有限的城市公共服务设施已成为国家和地方政府关注的重要民生问题。医疗卫生服务设施作为城市公共服务设施的重要载体之一,长期以来存在资源有限性和需求无限性的矛盾。深圳市医疗卫生事业自“十一五”以来快速发展,但依旧面临着资源总量不足、资源配置不均衡等诸多问题。为了有效促进医疗卫生事业的均衡发展,以满足市民对医疗服务的基本需求,深圳市提出了以公平为首要目标的医疗服务设施的区域卫生规划,在进行医疗服务设施的配建中,要以人为本,根据实际需求进行规划和调整。公共服务设施在城市中是稀缺资源,通常分布并不均衡。如何评定公共资源的公平性,通过何种指标来对其进行评价,一直以来是国内外学者研究重点之一。本文基于深圳市医疗发展现状,选取87家综合医院为研究对象,以空间公平性为视角,结合实地调研和GIS等多种技术手段,采用“区位熵”、“空间叠置”和“潜能改型模型”等多种测度方法,对深圳市综合医院的医疗资源空间供给、空间需求、空间可达性三方面做出较为系统的测度和评价,分析综合医院的规划和建设问题,为医疗卫生设施相关规划和建设提出意见和建议。研究发现,深圳市综合医院空间公平性问题较为突出。首先,医疗资源空间供给上呈现出数量、质量、规模的不均衡现象,中心组团综合医院数量高、东部生态组团、东部工业组团低,千人床位数和千人执业医师数量则为中心组团和龙岗中心组团数值最高,而东、西部工业组团的对应数值偏低,中心组团综合医院医疗资源集聚程度高于全市平均值接近一倍,而东、西工业组团则低于全市平均值近乎一半。其次,空间需求上,综合医院与人口密度分布耦合度尚可,但在经济发展相对较慢、地理位置较为边缘的区域耦合度较差。空间布局的结构公平性差异化较大,机构数量、机构规模、服务质量、办医形式等呈现中部区域富集、周边区域匮乏的现象。第三,空间可达性上,深圳市综合医院可达性水平整体偏低,区域间可达性水平差异较大,空间可达性在综合医院较为密集、层级结构较为完善的中心组团区域水平较高,但由于医院分布过于密集,其服务辐射的范围有限。中部综合组团尽管综合医院数量和质量远不及中心组团,但由于医院空间分布较为均衡,其可达性辐射范围比中心组团广泛。基于上述研究发现,本文建议应当进一步加大医疗卫生资源的投入,并优先考虑向资源较为匮乏的区域倾斜。建设高效的区域医疗中心,完善部分区域内医院等级体系、优化医院空间布局。充分利用现有医院资源,提高医疗资源的使用效率,对于医疗资源较为集中,或者医院位置不合理的区域,则可以考虑通过调整医院的位置来提升医院的服务效率,增加医院医疗服务的覆盖范围。对于区域医疗资源分布不均衡的现象,则可以通过调整医院等级,将已有资源重新分配的方式进行区域间的协调。对于地广人稀的区域,应当加强基层医疗服务体系的建设,提升基层医疗服务水平和服务质量,以弥补高层级综合医院空间可达性上的不足。
[Abstract]:How efficient in the high-speed urbanization process in China, the city public service facilities Co., the fair has become an important problem of people's livelihood concern of state and local government. Medical and health services as an important carrier of city public service facilities, has long been the contradiction of the limited resources and unlimited demand of health care in Shenzhen. Since the cause of the "11th Five-Year" since the rapid development, but still facing resource shortage, uneven allocation of resources and many other issues. In order to effectively promote the balanced development of medical and health services, to meet the basic needs of the public health service, Shenzhen city put forward the regional health planning with justice as the primary goal of medical service facilities, in medical service facilities with the construction, should be people-oriented, planning and adjustment according to the actual needs. Public service facilities are scarce resources in the city The source, usually distribution is not balanced. How to evaluate the fairness of public resources, through which indicators to evaluate, always is one of the important researches of scholars at home and abroad. This paper based on the current situation of Shenzhen City medical development, selected 87 general hospitals as the research object, with fair space perspective, combined with field investigation and GIS etc. a variety of techniques, using the "location entropy", "spatial overlay method" and "potential modification model" and other measures, the space requirement of medical resources supply, general hospital in Shenzhen City, to measure and evaluate systematically three aspects of spatial accessibility, problems of planning and construction of general hospital, comments and suggestions for the planning and construction of health care facilities. The study found that Shenzhen city space general hospital fairness problem is more prominent. First, the medical resources supply showed a number of space, The quality of uneven size, central group general hospital number is high, the eastern ecological group, industrial group in east low, thousands of beds and thousands of practitioners for number of central group and Longgang center group the highest value, and the corresponding numerical low East, western industrial groups, the central group general hospital medical resources agglomeration higher than the average value of nearly doubled, while the East and West Industrial Group is lower than the average value of nearly half. Secondly, space requirements, general hospital and population density distribution of the coupling degree is acceptable, but in the economic development phase of slow, location is the edge of the regional coupling structure is poor. The spatial layout of fairness a large number of agencies, institutions, scale, quality of service, do medicine form of the central region is enriched, surrounding area deficient phenomenon. Third, accessibility, up to general hospitals in Shenzhen City The overall low level of accessibility level of inter regional differences in large space accessibility in general hospitals is more intensive, the hierarchical structure of perfect regional center city level is high, but because the hospital distribution is too dense, the service range of radiation is limited. Although the quantity and quality of the central comprehensive group general hospital, far less than the central area, but due to the hospital the spatial distribution is more balanced, the accessibility of the radiation range than the central group. Based on the above findings, this paper suggests that we should further increase health investment, and to give priority to the resources scarce areas tilt. The regional medical center, the perfect part of the regional hospital grading system, optimize the hospital make full use of space layout. The existing hospital resources, improve the efficiency of the use of medical resources, medical resources are concentrated in the hospital, or positions are not reasonable Area can be considered by adjusting the position of the hospital to improve the efficiency of hospital services, increase the coverage of hospital medical service. The unbalanced distribution of regional medical resources, can be adjusted by the hospital level, the re allocation of existing resources for coordination between regions. For the area with much land and few people shall strengthen the construction of grass-roots level. The medical service system, improve the medical service level and service quality, to make up for lack of high level comprehensive hospitals on spatial accessibility.

【学位授予单位】：深圳大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：TU246.181

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