青海省衛生資源配置問題探析-藏刊網

摘要

目的本文通過分析 2011-2014 年青海省的衛生資源配置現狀，評價衛生資源配置的公平性，來了解青海省當前衛生資源配置中存在的問題，從而為衛生資源進行優化配置，為提高衛生資源配置的公平性提出合理化的建議，并為當地政府和有關部門制定區域衛生規劃提供政策性的參考，更好的為提高人民群眾的健康服務，進而促進青海省的衛生事業向著協調、持續的方向發展。

方法本文的研究方法包括文獻檢索、描述性分析、定量研究方法等。青海省的社會經濟概況以及衛生資源配置現狀分析，主要運用了文獻研究、描述性分析方法; 青海省衛生資源配置的公平性，主要運用了經濟學方法，即洛倫茲曲線、基尼系數、泰爾指數; 通過定量研究，分析了青海省 2011-2014 年衛生資源配置的人口分布公平性與地理分布公平性，以及區域間與區域內的差異。

結果

1.青海省衛生資源配置現狀

（1）衛生人力資源各指標呈穩步增長狀態：2011-2014 年青海省的衛生人力資源呈逐年上升的趨勢，其中衛生人員數從 2011 年的 31036 人增長到 2014 年的38673 人，年平均增長率為 6.15%，衛生技術人員從 2011 年的 26132 增長到 2014年的33138人，年平均增長率為6.70%，注冊護士從2011年的 9368人增長到2014年的 12961 人，年平均增長率為 9.56%，執業（助理）醫師數從 2011 年到 2013年逐漸增長，2014 年有所下降，由 12069 人下降到 11960 人，四年平均增長率為 4.82%。

（2）衛生物力資源呈逐年上升的趨勢：青海省醫療機構數從 2011 年的 5890個增加到 2014 年的 6241 個，增加了 351 個，其中醫院、基層衛生機構、公共衛生機構等都有一定數量的增加。醫療機構床位數從2011年的23171張增加到2014年的 33107 張，增加了近一萬張床位。2011-2014 年青海省每千人口床位數呈逐年上升的趨勢，由 4.18 張增長到 5.71 張，與全國同期水平相比較均高一些，但是與一些發達城市的每千人口床位數相比，則仍有較大差距。

（3）青海省衛生總費用不斷增長，但人均費用低于全國水平：青海省衛生總費用從 2011 年的 561573.30 萬元增長到 2014 年的 952546.50 萬元，增長了390973.2 萬元，人均衛生費用呈逐年上升的趨勢，從 2011 年的人均 1007.15 元增長到了 2014 年的人均 1641.86 元，但與全國水平相比仍有一定的差距。青海省各地區之間衛生機構收入與支出不均衡，存在著很大差距。

2.青海省衛生資源配置的公平性

（1）基尼系數分析青海省衛生資源配置的公平性青海省衛生資源按照人口分布的公平性相對較好：洛倫茲曲線繪制出的彎曲程度較小，與絕對公平線較近，衛生人力資源的基尼系數小于 0.4，說明衛生人力資源按照人口分布處于正常的狀態。醫療機構床位數按照人口分布的公平性也相對較好，洛倫茲曲線繪制出的彎曲程度較小，與絕對公平線較近，基尼系數小于 0.3，表明處于最佳的平均狀態。

青海省衛生資源按照地理分布的公平性相對較差：洛倫茲曲線其彎曲程度較大，偏離絕對公平線，衛生資源的基尼系數均處于 0.6-0.8 之間，說明衛生人力資源按照地理分布處于高危的絕對不公平狀態。

（2）泰爾指數分析青海省衛生資源配置的公平性衛生人力資源的總泰爾指數相對較小，其中注冊護士的泰爾指數相對其他指標較高一些。將總泰爾指數分解，區域間貢獻率大，區域內貢獻率較小，則可以說明衛生人力資源的配置是不均衡的，并且主要原因在于各類地區間存在的差異。醫療機構床位數的總泰爾指數也較小，將總泰爾指數分解后得到區域間貢獻率大，區域內貢獻率小，說明床位數的配置也是不平衡的，造成不公平的主要原因在于各類地區間存在的差異。

結論（1）青海省衛生資源總量基本足夠，并呈持續增長狀態，但資源分布不均衡。（2）青海省衛生資源配置的人口公平性明顯優于地理公平性, 各項衛生資源按人口分布的基尼系數處于較好的平均狀態，而地理公平性均超過了警戒狀態，表現出高度不公平性。（3）青海省衛生資源配置總體上處于比較公平的狀態，區域間差異是造成青海省衛生資源配置不均衡的主要原因。（4）青海省護理人力資源總量不足，醫護比遠低于國家 1:2 的標準。護理人員的長期缺乏是影響青海省醫療保障水平的關鍵因素。

關鍵詞：青海省，衛生資源配置，現狀，公平性

Abstract

Objective: To identify the existing problems in the current allocation of healthresources in Qinghai Province according to the analysis on the status and equity ofallocation of health resources in Qinghai Province from 2011 to 2014. In addition tothe optimal allocation of health resources, the reasonable suggestions are alsoproposed to improve the equity of allocation of health resources and the policyreferences are provided for the local government and departments concerned toprepare the regional health planning, which can improve the health of people and thusdrive the development of health service in Qinghai Province to the coordinated andsustainable direction.

Methods: The research methods in this paper included the document retrieval,descriptive analysis and quantitative research. The document retrieval and descriptiveanalysis were employed to introduce the social and economic situation and analyzethe status of allocation of health resources in Qinghai Province; the economicmethods, namely Lorenz curve, Gini coefficient and Theil index, were adopted toevaluate the equity of allocation of health resources in Qinghai Province; and thequantitative research was used to analyze the equity of allocation of health resourcesregarding the population distribution and geographical distribution and the differencebetween regions in Qinghai Province from 2011 to 2014.

Results:

1. Status ofAllocation of Health Resources in Qinghai Province\\(1\\) The indexes of human resources for health were increased steadily: the humanresources for health in Qinghai Province were increased year by year from 2011 to2014, where the number of health personnel was increased from 31,036 in 2011 to38,673 in 2014, with the annual growth rate of 6.15%; the number of healthprofessionals from 26,132 in 2011 to 33,138 in 2014, with the annual growth rate of6.70%; the number of registered nurses from 9,368 in 2011 to 12,961 in 2014, withthe annual growth rate of 9.56%; the number of practicing \\(assistant\\) physicians wasgradually increased from 2011 to 2013, but a bit decreased in 2014 from 12,069 to11,960, with the annual growth rate of 4.82% in four years.

\\(2\\) The material resources for health were increased year by year: The number ofmedical institutions was increased by 351 from 5,890 in 2011 to 6,241 in 2014, wherethe number of hospitals, grass-root health facilities and public health facilities werealso increased . The number of beds in medical institutions was increased by nearly10,000 from 23,171 in 2011 to 33,107 in 2014. The number of beds per 1000population was increased from 4.18 in 2011 to 5.71 in 2014 in Qinghai Province,which was a bit higher than the national level over the same period. But there was thelarge gap compared with the one in some developed cities.

\\(3\\) The total health expenditure was gradually increased in Qinghai Province, butthe expenditure per person was lower than the national level: The total healthexpenditure was increased by RMB 39.09732 million Yuan from RMB 561.57330million Yuan in 2011 to RMB 952.54650 million Yuan in 2014 in Qinghai Province;while the expenditure per person was increased year by year from RMB 1007.15 Yuanin 2011 to RMB 1641.86 Yuan in 2014, but there was the certain gap compared withthe national level. There was the significant difference in the income and expenditureof medical institutions among regions in Qinghai Province.

2. Equity of Allocation of Health Resources in Qinghai Province\\(1\\) Analysis on Equity of Allocation of Health Resources in Qinghai Provinceusing Gini Coefficient

The equity of allocation of health resources regarding the population distributionin Qinghai Province was relatively good: The curvature of Lorenz curve was smalland it was close to the absolute equity line. The Gini coefficient of human resourcesfor health was less than 0.4, which indicated that the human resources for health wasin the normal state regarding the population distribution. The equity of the number ofbeds in the medical institutions regarding the population distribution was relativelygood. Where, the curvature of Lorenz curve was small and it was close to the absoluteequity line. Its Gini coefficient was less than 0.3, which indicated that it was in theoptimal average state.

The equity of allocation of health resources regarding the geographicaldistribution in Qinghai Province was relatively poor: The curvature of Lorenz curvewas large and it was deviated from the absolute equity line. The Gini coefficient ofhealth resources was between 0.6-0.8, which indicated that the human resources forhealth regarding the geographical distribution was in the dangerous state of absoluteinequity state.

\\(2\\) Analysis on Equity of Allocation of Health Resources in Qinghai Provinceusing Theil Index

The total Theil index of human resources for health was relatively small, wherethe Theil index of registered nurse was higher than other indexes. By decomposingthe total Theil index, the inter-regional contribution rate was large and theintra-regional contribution rate was small, which indicated that the allocation ofhuman resources for health was unbalanced, with the main reason of differenceamong regions. The total Theil index of the number of beds in medical institutionswas also small. By decomposing the total Theil index, the inter-regional contributionrate was large and the intra-regional contribution rate was small, which indicated thatthe allocation of the number of beds was also unbalanced, with the main reason ofdifference among regions.

Conclusion: \\(1\\) The total amount of health resources in Qinghai Province isbasically sufficient and shows the trend of constantly increasing. But the allocation ofresources is unbalanced. \\(2\\) The population equity of allocation of health resources inQinghai Province is significantly better than the geographical one. The Ginicoefficient of health resources regarding the population distribution is in the goodaverage state, while the geographical equity exceeds the risk level, showing the highinequity. \\(3\\) The allocation of health resources in Qinghai Province is in the state ofequity as a whole. The difference among regions is the main reason for theunbalanced allocation of health resources in Qinghai Province. \\(4\\) The total amountof human resources for nursing in Qinghai Province is insufficient and its ratio ofphysicians and nurses is far lower than the national level of 1:2. The long-term lack ofnursing personnel is the key factor to affect the level of medical security in QinghaiProvince.

Keywords: Qinghai Province; Allocation of Health Resources; Status; Equity

目錄

中文摘要

Abstract

1 前言

1.1 研究背景

1.2 國內外研究現狀

1.3 目的意義

2 研究內容與方法

2.1 研究內容與資料來源

2.2 研究方法

2.3 技術路線