海南省医疗卫生资源配置的公平性研究

发布时间：2018-07-10 01:46

本文选题：泰尔指数 + 基尼系数　；参考：《海南师范大学》2016年硕士论文

【摘要】：卫生服务公平性是世界卫生组织对各国卫生服务绩效评估的一个重要指标,而卫生资源配置公平性是卫生服务公平性的前提。如何使卫生资源公平且有效地在不同的领域、人群、项目中分配,从而实现卫生资源的社会和经济效益最大化是各界关注的热点问题。2009年国家《关于深化医药改革卫生体制的意见》中明确指出,要充分优化整合配置现有卫生资源,促进基本公共卫生服务逐步均等化,可见医疗卫生资源配置的公平性的重要程度。本文通过分析海南省卫生资源配置现状,系统评价卫生资源配置公平性,探讨各类卫生资源配置在公平性方面存在的问题,为促进海南省卫生事业持续、协调、稳定的发展提供理论依据和方法支持。本研究采用统计描述方法对海南省卫生资源现状进行分析;利用基尼系数和泰尔指数对海南省各类卫生资源按人口分布、地理分布公平性进行分析与评价;同时,构建医疗卫生资源配置指标体系,提出达标度和均衡度概念,并利用相对误差距离和熵值法相结合,得出与医疗体系配套的指标权重,并利用多属性决策方法对海南省18个市县进行综合评价。研究结果显示:2009 2013年期间,海南省卫生资源配置数量和质量不断提升,但每千人口卫生资源占有量较低。2012年,除每千人口卫技人员和注册护士比全国平均水平高之外,其余各类卫生资源人均占有量仍低于全国平均人均水平;卫生资源配置数量是经济发达地区占优,且这五年期间不同经济发展地区的人均医疗卫生资源拥有量的差距没有变化;海南省卫生资源配置按人口分布的公平性不断提高,而按地理位置的公平性没有太大变化,且基尼系数显示的结果是按人口分布的卫生资源分配公平性好于按地理分布的卫生资源分配公平性,其中各类卫生资源的人口分布基尼系数都在0.3以下,公平性都处于最佳状态,而卫生技术人员、床位、医师和护士按地理分布的基尼系数都高于0.4,公平性处于警戒状态;地区的经济发展对医疗卫生资源配置有很大的影响,卫生资源配置的水平会随着经济地不断发展而提高,地区经济发展的水平不同,其医疗卫生资源的配置公平性情况也各不相同,经济发达地区和中等发达地区内部医疗卫生资源配置的均衡性比较好,而欠发达地区内部医疗卫生资源配置的均衡性较差;不同经济发展地区之间除了卫生机构之外的医疗卫生资源配置差异缩小,但区域之间的非均衡性仍是造成海南省卫生资源配置不均衡的主要原因;从达标度的角度来分析海南省卫生资源的分配,发现海南省的平均达标度相对较低,利用多属性决策方法对海南省各市县医疗卫生配置进行综合评价,发现海南省在各市县卫生资源的分配、投入问题上存在一些不合理之处,各市县的整体医疗卫生资源配置相差悬殊。
[Abstract]:The equity of health service is an important indicator of health service performance evaluation in the world health organization, and the equity of health resource allocation is the premise of health service fairness. How to equitably and effectively distribute health resources across different areas, people, projects, Therefore, to maximize the social and economic benefits of health resources is a hot issue concerned by all circles. It is clearly pointed out in the National opinion on deepening the Reform of the Health system in 2009 that it is necessary to optimize and integrate the existing health resources. To promote the equalization of basic public health services, we can see the importance of fairness in the allocation of medical and health resources. By analyzing the present situation of health resources allocation in Hainan Province, this paper systematically evaluates the equity of health resources allocation, and discusses the problems existing in the fairness of all kinds of health resources allocation, in order to promote the continuity and coordination of health services in Hainan Province. The steady development provides the theoretical basis and the method support. This study uses the statistical description method to analyze the current situation of health resources in Hainan Province; uses Gini coefficient and Thiel index to analyze and evaluate the distribution of all kinds of health resources in Hainan Province according to the population distribution and the fairness of geographical distribution; at the same time, The index system of medical and health resources allocation is constructed, the concepts of standard degree and equilibrium degree are put forward, and the index weights matching with medical system are obtained by combining the relative error distance and entropy method. The multi-attribute decision-making method is used to evaluate 18 cities and counties in Hainan province. The results of the study show that the quantity and quality of health resources allocation in Hainan Province increased continuously during the period between 2009 and 2013, but the amount of health resources per 1,000 people was relatively low. In 2012, except for health professionals and registered nurses per 1,000 people, the level of health resources was higher than the national average. The per capita possession of other kinds of health resources is still lower than the average per capita level of the whole country, the allocation of health resources is dominant in the economically developed regions, and the difference of the per capita medical and health resources in different economic development areas has not changed during these five years. The fairness of the distribution of health resources according to the population in Hainan Province has been continuously improved, but the fairness of the distribution according to geographical location has not changed much. The result of Gini coefficient is that the fairness of distribution of health resources by population is better than that by geographical distribution, and the Gini coefficient of population distribution of all kinds of health resources is below 0.3. Fairness is in the best condition, and the Gini coefficient of health technicians, beds, doctors and nurses according to geographical distribution is higher than 0.4, and fairness is on the alert; the economic development of the region has a great impact on the allocation of medical and health resources. The level of allocation of health resources will increase with the continuous development of economy. The level of regional economic development varies, and the fairness of the allocation of medical and health resources varies from region to region. The balance of medical and health resources in the economically developed areas and the moderately developed areas is better than that in the less developed areas. The difference in allocation of medical and health resources between different economic development areas except health institutions is reduced, but the imbalance between regions is still the main reason for the imbalance of health resources allocation in Hainan Province. The distribution of health resources in Hainan Province is analyzed from the point of view of reaching the standard. It is found that the average standard degree of Hainan Province is relatively low. The multi-attribute decision-making method is used to comprehensively evaluate the medical and health allocation of each city and county in Hainan Province. It is found that there are some unreasonable problems in the allocation and investment of health resources in all cities and counties in Hainan Province, and there are great differences in the overall allocation of medical and health resources among the cities and counties.
【学位授予单位】：海南师范大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.1

【参考文献】