监测地区产科资源配置和利用现状及公平性研究
[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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