监测地区产科资源配置和利用现状及公平性研究
发布时间：2018-10-23 16:07
【摘要】：研究目的通过分析监测地区各类助产机构产科资源配置和利用现状以及产科资源分布的公平性,来评价监测地区产科资源配置是否充足合理。为合理配置产科资源提供数据依据,也为各地应对生育政策的调整提供政策建议。研究方法利用中国疾病预防控制中心妇幼保健中心开展的调整完善生育政策对妇幼健康服务影响监测项目所收集的监测信息,对我国4个监测地区全部助产机构的产科资源配置情况进行分析。统计描述产科资源配置和利用情况以及变化趋势,采用供需评价法对监测地区产科床位的供需状态进行评价,利用洛伦兹曲线、基尼系数和泰尔指数分析评价监测地区产科资源配置的公平性。研究结果2013年监测地区每千常住人口拥有0.27张产科床位、0.12名产科医生、0.23名产科护士(其中含有0.08名助产士)；每平方公里拥有0.50张产科床位、0.22名产科医生和0.44名产科护士(其中含有0.15名助产士)；供需评价法发现监测地区产科床位的供需比为1.10,处于基本平衡状态。2013-2015年开放床位呈现逐年增加的趋势,2015年比2013年增长2.13%。监测地区平均开放11815张产科床位,不同等级助产机构中,三级助产机构所占比例最高(46.93%),其次是二级助产机构(34.97%),一级及未评级助产机构所占比例最低(18.10%)；各级助产机构以三级助产机构的床位使用率最高(95.77%),二级次之(74.90%),一级及未评级最低(54.16%)；不同类别助产机构中,以妇幼保健院(94.10%)床位使用率最高,综合医院次之(86.99%),社区／乡镇卫生院最低(26.36%)。监测地区共有14960名产科医护人员,不同等级助产机构中,三级、二级和一级及未评级分别占48.99%、34.08%和16.93%,分别承担了54.24%、33.68%和12.08%的分娩量和53.47%、33.94%和12.59%的门诊量。各级助产机构的医护比分别为1：2.05、1：1.88和1：1.77,床护比分别为1：0.88、1：0.81和1：0.75。每千活产拥有的产科医生数、护士数及助产士数均以三级助产机构最少(分别为7.74、15.98和5.59),二级次之(分别为9.31、17.52和6.57),一级及未评级最多(分别为13.31、23.52和7.69)。不同类别助产机构中,以妇幼保健院每千活产拥有的医护人员数最少。不同等级助产机构中,以三级助产机构产科医护人员的工作负荷最重,产科医生的人均年助产服务效率、人均年门诊量和人均年担负床日分别高达191.28、2765.56人次/人/年和1046.74床日/人/年,一级及未评级最低,三类指标分别为75.16、1233.26人次/人/年和436.12床日/人/年；不同类别助产机构中,以妇幼保健院产科医护人员的工作负荷最重,社区/乡镇卫生院的工作负荷最轻。监测地区各产科资源按孕产妇分布的基尼系数均小于0.3；按户籍人口分布,产科床位、产科医生和助产士的基尼系数在0.3-0.4之间,而产科护士的基尼系数为0.41；各产科资源按地理面积分布的基尼系数均在0.6以上。通过贡献率分析发现,各产科资源城市间的差异对监测地区按地理分布不公平的影响仅占30%左右,城市内的差异是引起不公平的主要原因。研究结论监测地区每千人口和每平方公里产科资源配置水平虽高于全国平均水平,但仍低于部分中低等收入国家,产科资源相对不足。与此同时,存在着产科资源在各类助产机构(不同等级、不同类别)间分布不合理的问题,其中三级助产机构和妇幼保健院的产科资源相对不足,且处于超负荷利用状态；基层助产机构(一级及未评级助产机构、社区/乡镇卫生院等)产科床位使用率偏低,工作负荷也相对较轻,部分产科资源处于闲置状态。监测地区产科资源在地理分布上也存在着严重的公平性问题,从而影响产科资源的利用效率和地理可及性。建议适当增加产科资源数量,并调整产科资源在各类助产机构间的配置,加强落实分级诊疗制度,同时在产科资源配置时考虑地理的可及性。
[Abstract]:Objective To evaluate the adequacy and rationality of obstetric resources allocation in monitoring areas by analyzing the status of obstetric resources allocation and utilization and the equity of obstetric resources distribution in various midwifery institutions in the area. To provide data basis for rational allocation of obstetric resources, policy recommendations are also provided for the adjustment of fertility policies throughout the country. Methods The monitoring information collected by maternal and child health care center of China Center for Disease Control and Prevention was used to monitor the monitoring information collected by maternal and child health services, and to analyze the distribution of obstetric resources in all midwifery institutions in four monitoring areas in China. The supply and demand status of obstetric beds in the monitoring areas were evaluated by means of supply and demand evaluation, and the fairness of obstetric resources allocation in monitoring areas was evaluated by means of logistic curve, Gini coefficient and Terkel index. The results of the study included a total of 0. 27 obstetric beds per thousand inhabitants in 2013, 0,12 obstetricians, 0. 23 obstetric nurses (including 0. 08 midwives); 0. 50 obstetric beds per square kilometre, 0,22 obstetricians and 0,44 obstetricians (including 0. 15 midwives); The supply and demand evaluation method found that the supply and demand ratio of obstetric beds in the monitoring area was 1. 10, which was in the basic balance state. In 2013-2015, the open bed showed a trend of increasing year by year, which increased by 2.13% in 2015 than in 2013. The average open 11815 obstetric beds in the monitoring area, with the highest proportion of three-stage midwifery institutions (46. 93%), followed by secondary midwifery (34.97%), the lowest percentage of the primary and non-rated midwifery institutions (18.10%); The highest utilization rate (95. 77%), second order (74. 90%), primary and non-rated lowest (54. 16%) in midwifery institutions at all levels; in different types of midwifery institutions, the highest utilization rate of beds in maternal and child health care (94.1%) was the second (86. 99%). Community/ township health centers (26. 36%). There were 14,960 obstetrical and medical personnel in the surveillance area, with the three levels, secondary and primary and non-rated at 48. 99%, 34. 08% and 16.93%, respectively, with 54,24%, 33.68% and 12.08% of parturition and 53. 47%, 33.94% and 12.59% of outpatient. The ratio of medical care ratio of midwifery institutions at all levels was 1: 2.05, 1: 1.88 and 1: 1.77, respectively. The bed protection ratio was 1: 0. 88, 1: 0. 81 and 1: 0. 75, respectively. The number of obstetricians per thousand live births, the number of nurses and the number of midwives were the least (7.74, 15.98 and 5.59), followed by level two (9.31, 17.52 and 6.57, respectively), and the highest and unrated (13. 31, 23. 52 and 7. 69, respectively). In different types of midwifery institutions, the number of health care workers per 1,000 live births in the Maternal and Child Health Care Hospital is the least. In different grade midwifery institutions, the work load of obstetric care workers in three-stage midwifery institutions is the heaviest, the per-capita annual attendance rate of obstetricians, the per capita annual outpatient service and the average annual per capita per capita are 191. 28, 2765. 56 times per person/ year and 1046. 74 beds day/ person/ year, the first and the non-rated lowest, Three kinds of indicators were 75. 16, 1233. 26 person-time/ person/ year and 436. 12 bed days per person/ year respectively; in different kinds of midwifery institutions, the workload of obstetric care workers in MCH hospital was the heaviest, and the workload of community/ township health centers was the most light. According to the distribution of household registration population, obstetric beds, obstetrician and midwife, the basic Nini coefficient of obstetric nurses was 0. 3-0. 4, while the basic Nini coefficient of obstetric nurses was 0. 41; The Gini coefficient of every obstetric resource distribution according to geographical area is above 0. 6. Through the analysis of the contribution rate, the difference in the urban areas of the obstetric resources accounts for only about 30% of the geographical distribution of the monitoring areas, and the difference in the cities is the main cause of injustice. The results showed that the distribution level of obstetric resources in every 1000 and per square kilometre in the monitoring area was higher than that of the national average, but still lower than those in the middle and lower income countries, and the obstetric resources were relatively inadequate. At the same time, there is an unreasonable distribution of obstetric resources among various midwifery institutions (different grades and different categories), among which the obstetric resources of the three-level midwifery and maternal and child health clinics are relatively inadequate and are in an overload state; The utilization rate of obstetric beds in the grassroots midwifery institutions (primary and non-graded midwifery institutions, community/ township hospitals, etc.) is low, and the workload is relatively light, and some of the obstetric resources are in an idle state. There are serious fairness problems in the geographical distribution of obstetric resources in the monitoring area, thus affecting the utilization efficiency and geographical accessibility of the obstetric resources. It is recommended that the number of obstetric resources be increased appropriately, and the allocation of obstetric resources among various midwifery institutions should be adjusted to strengthen the implementation of the hierarchical diagnosis and treatment system, while taking into account the geographical accessibility in the allocation of obstetric resources.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R17
本文编号：2289752
[Abstract]:Objective To evaluate the adequacy and rationality of obstetric resources allocation in monitoring areas by analyzing the status of obstetric resources allocation and utilization and the equity of obstetric resources distribution in various midwifery institutions in the area. To provide data basis for rational allocation of obstetric resources, policy recommendations are also provided for the adjustment of fertility policies throughout the country. Methods The monitoring information collected by maternal and child health care center of China Center for Disease Control and Prevention was used to monitor the monitoring information collected by maternal and child health services, and to analyze the distribution of obstetric resources in all midwifery institutions in four monitoring areas in China. The supply and demand status of obstetric beds in the monitoring areas were evaluated by means of supply and demand evaluation, and the fairness of obstetric resources allocation in monitoring areas was evaluated by means of logistic curve, Gini coefficient and Terkel index. The results of the study included a total of 0. 27 obstetric beds per thousand inhabitants in 2013, 0,12 obstetricians, 0. 23 obstetric nurses (including 0. 08 midwives); 0. 50 obstetric beds per square kilometre, 0,22 obstetricians and 0,44 obstetricians (including 0. 15 midwives); The supply and demand evaluation method found that the supply and demand ratio of obstetric beds in the monitoring area was 1. 10, which was in the basic balance state. In 2013-2015, the open bed showed a trend of increasing year by year, which increased by 2.13% in 2015 than in 2013. The average open 11815 obstetric beds in the monitoring area, with the highest proportion of three-stage midwifery institutions (46. 93%), followed by secondary midwifery (34.97%), the lowest percentage of the primary and non-rated midwifery institutions (18.10%); The highest utilization rate (95. 77%), second order (74. 90%), primary and non-rated lowest (54. 16%) in midwifery institutions at all levels; in different types of midwifery institutions, the highest utilization rate of beds in maternal and child health care (94.1%) was the second (86. 99%). Community/ township health centers (26. 36%). There were 14,960 obstetrical and medical personnel in the surveillance area, with the three levels, secondary and primary and non-rated at 48. 99%, 34. 08% and 16.93%, respectively, with 54,24%, 33.68% and 12.08% of parturition and 53. 47%, 33.94% and 12.59% of outpatient. The ratio of medical care ratio of midwifery institutions at all levels was 1: 2.05, 1: 1.88 and 1: 1.77, respectively. The bed protection ratio was 1: 0. 88, 1: 0. 81 and 1: 0. 75, respectively. The number of obstetricians per thousand live births, the number of nurses and the number of midwives were the least (7.74, 15.98 and 5.59), followed by level two (9.31, 17.52 and 6.57, respectively), and the highest and unrated (13. 31, 23. 52 and 7. 69, respectively). In different types of midwifery institutions, the number of health care workers per 1,000 live births in the Maternal and Child Health Care Hospital is the least. In different grade midwifery institutions, the work load of obstetric care workers in three-stage midwifery institutions is the heaviest, the per-capita annual attendance rate of obstetricians, the per capita annual outpatient service and the average annual per capita per capita are 191. 28, 2765. 56 times per person/ year and 1046. 74 beds day/ person/ year, the first and the non-rated lowest, Three kinds of indicators were 75. 16, 1233. 26 person-time/ person/ year and 436. 12 bed days per person/ year respectively; in different kinds of midwifery institutions, the workload of obstetric care workers in MCH hospital was the heaviest, and the workload of community/ township health centers was the most light. According to the distribution of household registration population, obstetric beds, obstetrician and midwife, the basic Nini coefficient of obstetric nurses was 0. 3-0. 4, while the basic Nini coefficient of obstetric nurses was 0. 41; The Gini coefficient of every obstetric resource distribution according to geographical area is above 0. 6. Through the analysis of the contribution rate, the difference in the urban areas of the obstetric resources accounts for only about 30% of the geographical distribution of the monitoring areas, and the difference in the cities is the main cause of injustice. The results showed that the distribution level of obstetric resources in every 1000 and per square kilometre in the monitoring area was higher than that of the national average, but still lower than those in the middle and lower income countries, and the obstetric resources were relatively inadequate. At the same time, there is an unreasonable distribution of obstetric resources among various midwifery institutions (different grades and different categories), among which the obstetric resources of the three-level midwifery and maternal and child health clinics are relatively inadequate and are in an overload state; The utilization rate of obstetric beds in the grassroots midwifery institutions (primary and non-graded midwifery institutions, community/ township hospitals, etc.) is low, and the workload is relatively light, and some of the obstetric resources are in an idle state. There are serious fairness problems in the geographical distribution of obstetric resources in the monitoring area, thus affecting the utilization efficiency and geographical accessibility of the obstetric resources. It is recommended that the number of obstetric resources be increased appropriately, and the allocation of obstetric resources among various midwifery institutions should be adjusted to strengthen the implementation of the hierarchical diagnosis and treatment system, while taking into account the geographical accessibility in the allocation of obstetric resources.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R17
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