我国新医改前后卫生资源配置公平性分析

摘要

目的:描述和对比2006—2015年新医改前后我国卫生资源配置情况、差异及其公平性变化.方法:用省级数据分析执业(助理)医师数和医疗卫生机构床位数配置的公平性,将我国31个省、自治区、直辖市按人均GDP和地理区域分为五个不同收入组和东中西三组,极差法、比例法和集中指数法分别用于比较和评价新医改前后不同组间的绝对差异、相对差异和相对公平性.结果:我国卫生资源配置(1)数量逐年增加,新医改后增长率高于新医改前;(2)不同经济发展水平地区卫生资源差异逐渐减小,新医改后减小速度加快;(3)不同地区床位配置差异减小,执业(助理)医师差异在新医改后有所拉大;(4)我国卫生资源配置公平性得到提高,新医改后的改善程度优于新医改前,但按地理面积分布的卫生资源仍处高度不公平状态.讨论:(1)新医改中加强卫生资源配置的政策得到一定程度的落实;(2)部分地区卫生资源数量仍需增加,尤其需要加强高质量卫生人才的培养;(3)在进行资源配置时,同时兼顾人口数量和地理面积大小.%This paper aims at describing and comparing the changes of health resources allocation before and after new health system reform during 2006—2015 . Methods:Province-level data were used to analyze the inequities of licensed ( assistant) doctors and beds. 31 provinces were divided into 5 groups by GDP per capita and 3 groups by geographical regions. Absolute difference, relative ratio and concentration index were respectively used to compare and measure the absolute difference, relative difference and inequities in different groups before and after the new health system reform. Results:The findings of this study show the allocation of China's health resource before and after new health system reform to be as below:(1) the quantity of health resource is increasing, and the growth rate after the reform is higher than before. (2) the disparities of health resource in different economic development level areas are declining, and the decrease is faster after the reform. (3) the disparity of beds in different regions is decreasing, but the disparity of licensed (assistant) doctors in different regions is enlarging. (4) The inequities of health resource al-location in China are reduced, and the improvement is greater after the reform than before. However, the health re-source allocation is still highly inequitable to geographical areas. Discussion:(1) the policies of health resource allo-cation implementation after the reform needs improvement. ( 2 ) The amount of health resource still needs to be in-creased in certain areas, especially need to strengthen the training of high-qualified health personnel. (3) When al-locating health resources, government should focus on the impact of both population and geographical size factors.