我国全科医生资源配置现状及公平性分析

摘要

Objective To investigate the status and equity of current distribution of general practitioners(GPs) in China.Methods This study was based on the data of distribution of GPs in 31 provinces(autonomous regions and municipalities) in China without Taiwan,Hong Kong Special Administrative Region and Macao Special Administrative Region.The data about population size(population),gross regional product(economy) and jurisdiction(geography) in every province(autonomous region,municipality) by the end of 2012,2013,and 2014 were from China Statistical Yearbook 2013,China Statistical Yearbook 2014,China Statistical Yearbook 2015;data about GPs were from China's Health and Family Planning Statistical Yearbook 2013,China's Health and Family Planning Statistical Yearbook 2014,and China's Health and Family Planning Statistical Yearbook 2015.Gini coefficient based on the Lorenz curve and Theil index were used to assess the equity of distribution of GPs in China from the aspects of population,economy and geography.Results There were 172 597 GPs in China in 2014,which increased by 18.61% compared with that of 2013,and by 57.20% compared with that of 2012.In 2014,the number of GPs accounted for 5.97% of the totaled registered(assistant) physicians;the average number of GPs delivering healthcare services for 10 000 persons in China was 1.27,specifically,that was 1.71,less than 1,less than 1,for 10 000 persons in eastern China,central China,and western China,respectively.From 2012 to 2014,the Gini coefficient for assessing the equity of access to GPs dropped from 0.313 2 to 0.252 6 by population,0.230 0 to 0.204 2 by the economy,0.742 4 to 0.717 6 by the geography;the Theil index for assessing the equity of access to GPs dropped from 0.075 2 to 0.049 4 by population,0.036 6 to 0.028 2 by the economy,0.591 7 to 0.540 5 by the geography.Conclusion In China from 2012 to 2014,the number of GPs increased significantly,but the overall distribution of GPs was unsatisfied;the distribution of GPs was not alanced,and it varied significantly from place to place;the equity of distribution of GPs was good if by population and economy,but poor by geography.%目的 了解我国全科医生资源配置的现状,评价全科医生资源配置的公平性.方法 以我国31个省、自治区及直辖市(除台湾、香港特别行政区、澳门特别行政区)的全科医生相关数据为研究资料.各地区年末人口数(人口)、地区生产总值(经济)及辖区面积(地理)资料来源于《中国统计年鉴》(2013-2015年);全科医生数据来源于《中国卫生和计划生育统计年鉴》(2013-2015年).运用洛伦兹曲线、基尼系数及泰尔指数对我国2012-2014年全科医生资源在人口、经济及地理分布的公平性进行评价.结果 2014年,我国全科医生总数为172 597人,较2013年增长了18.61%,较2012年增长了57.20%;全国全科医生数占执业(助理)医师数的比例为5.97%;每万人口全科医生配置数为1.27人,其中东部地区为1.71人,中部和西部地区每万人口全科医生配置数均不足1人.2012-2014年,基尼系数人口由0.313 2降到0.252 6,基尼系数经济由0.230 0降到0.204 2,基尼系数地理由0.742 4降到0.717 6;泰尔指数人口由0.075 2降到0.049 4,泰尔指数经济由0.036 6降到0.028 2,泰尔指数地理由0.591 7降到0.540 5.结论 我国全科医生数量增长显著,但配置总量仍显不足;全科医生分布不均衡,地区之间差异大;全科医生配置按人口、经济分布公平性较好,按地理面积分布公平性差.