对农村养老护理保健卫生资源配置问题的思考简

目的：了解与提出深化医改形势下人口老龄化的现状及养老护理保健卫生资源配置的问题,为做好老年人养老护理保健工作提供政策依据。方法：主要用调查法和观察法等描述性研究的方法进行综合描述。结论：提出加强农村养老护理保健机构建设、培养农村养老护理保健机构人才等建议。     

利用双重体系进行卫生资源配置的模式探讨

有效利用卫生资源的最根本和最重要的途径之一，就是对卫生服务提供和卫生干预进行合理规划。卫生部门权利下放已经成了许多国家卫生改革的关键问题。从宏观上讲，这就要求卫生保健管理和健康促进规划工具的进一步发展。该在对卫生服务利用的相关影响因素进行研究的基础上，利用卫生服务可得性指数法的双重体系，发展和建立一种更科学、更符合实际的资源配置方法。     

关于实现卫生资源优化配置的思考

分析了当前卫生资源配置存在的主要问题进行，提出了实现卫生资源优化配置应遵循可及性、可得性、有效性和有序性的原则，以指导建立符合我国国情的卫生资源优化配置模式。     

Protecting resources for primary health care under fiscal federalism: options for resource allocation

The introduction of fiscal federalism or decentralization of functions to lower levels of government is a reform not done primarily with health sector concerns. A major concern for the health sector is that devolution of expenditure responsibilities to sub-national levels of government can adversely affect the equitable distribution of financial resources across local jurisdictions. Since the adoption of fiscal federalism in South Africa, progress towards achieving a more equitable distribution of public sector health resources (financial) has slowed down considerably. This study attempts to identify appropriate resource allocation mechanisms under the current South African fiscal federal system that could be employed to promote equity in primary health care (PHC) allocations across provinces and districts. The study uses data from interviews with government officials involved in the budgeting and resource allocation process for PHC, literature on fiscal federalism and literature on international experience to inform analysis and recommendations. The results from the study identify historical incremental budgeting, weak managerial capacity at lower levels of government, poor accounting of PHC expenditure, and lack of protection for PHC funds as constraints to the realization of a more equitable distribution of PHC allocations. Based on interview data, no one resource allocation mechanism received unanimous support from stakeholders. However, the study highlights the particularly high level of autonomy enjoyed by provincial governments with regards to decision making for allocations to health and PHC services as the major constraint to achieving a more equitable distribution of PHC resources. The national government needs to have more involvement in decision making for resource allocation to PHC services if significant progress towards equity is to be achieved.     

Morality and the limits of societal values in health care allocation

In this paper, we consider whether there is a clear moral justification for the proposal that societal value preferences (SVPs) should be included in Cost Effectiveness Analyses (CEA) of health care resource allocations. We argue, first, that proponents of the use of SVPs need to be clear about the relationship between these values and moral principles. In particular, once moral principles are accepted as ruling out some SVPs (such as those that are irrational or revealing prejudice), an account is required of why we need to appeal to SVPs rather than moral principles to determine a just division of health care resources. Secondly, we consider whether an independent moral justification might underwrite the use of SVPs. In various places in the literature the notions of representation, presumed consent and democratic decision making appear to be invoked as candidates for fulfilling this justificatory role. We discuss some problems with each of these justifications in the hope of eliciting a more comprehensive proposal from the proponents of SVPs. We conclude that, although a number of interesting proposals have been made, no compelling justification for including SVPs in CEA has yet been systematically articulated.     

长沙市2007—2013年卫生资源配置公平性分析

目的:探究长沙市2007—2013年卫生资源配置的公平性,为政府部门进行区域卫生规划提供参考。方法:对长沙市2007—2013年卫生资源配置变化情况进行一般统计描述;从长沙市9个区县的人口与地理配置角度,采用基尼系数和泰尔指数分析医生、护士和床位配置的公平程度及变化趋势。结果:(1)长沙市卫生资源人均拥有量逐步增加,其卫生资源主要集中在城区。(2)2007—2013年长沙市医生、护士和床位资源按人口配置的基尼系数为0.24~0.46,并在逐年减小;按地理配置的基尼系数在0.59~0.79,2009年达到最高值,之后呈逐年下降趋势。两类地区比较,城区卫生资源的基尼系数明显高于农村地区。各卫生资源中,护士的基尼系数最高。(3)泰尔指数与基尼系数的变化趋势基本一致,城区卫生资源配置的差异程度呈上升趋势,地区间差异对总的泰尔指数贡献率高于各区域差异。结论:总体上看,长沙市2007—2013年卫生资源配置的公平性呈逐年好转趋势,人口配置的公平性优于地理配置的公平性,农村地区资源配置的公平性优于城区,护士资源配置的公平性较差,地区间差异是影响长沙市卫生资源配置公平性的主要因素。     

Where efficiency saves lives: A linear programme for the optimal allocation of health care resources in developing countries

Morbidity and mortality are directly influenced by the available health care budget. In addition, the optimal allocation of this scarce resource to the different strata of the health care system depends on the health care priorities. This paper presents a linear programming model in order to analyse the impact of changes of the health care budget and the goal system of the health care system on the optimal allocation to preventive and curative medicine. The model demonstrates that the current resource allocation in developing countries is inefficient. This calls for a new emphasis on preventive medicine and primary care in the political processes in developing countries. This revised version was published online in August 2006 with corrections to the Cover Date.     

Micro macro integration: Reframing primary healthcare practice and community development in health

The idea of micro macro integration (MMI) provides a useful framework for thinking about primary healthcare (PHC) and community development in health (CD). PHC and CD are important strategies for addressing the structural determinants of health. They are each based on a powerful logic and have a significant body of support. However, while exemplary, even inspiring, instances of practice are common, attempts to replicate models of good practice (or ‘scale up’) often flounder. As frameworks for analysing this paradox, both PHC and CD have limitations, partly because they are overburdened with different and conflicting meanings. This paper explores an alternative framework based on a common aspiration of both PHC and CD: to effect change at both the micro level (meeting the immediate health needs of individuals, families and communities) and also at the macro level (of political, economic and social structures). The MMI framework assumes that health issues can be analysed at different levels of scale and of term (from the micro to the macro); that objectives and strategies can be conceived at these different levels; and that a coherent programme of activities can be conceived and implemented which addresses both the immediate and local problems and the larger scale and longer term phenomena that reproduce those patterns of need. The idea of MMI is less ambitious than either PHC or CD but (partly because of this) has value as a framework for analysing barriers to good practice.     

关于卫生资源分配问题的思考

卫生资源分配涉及到诸多方面的问题,要实现对卫生资源的公正合理分配,就应当坚持体现多元的公正标准和原则,以解决卫生资源分配中的具体冲突.     

Optimal allocation of resources over health care programmes: dealing with decreasing marginal utility and uncertainty

This paper addresses the problem of how to value health care programmes with different ratios of costs to effects, specifically when taking into account that these costs and effects are uncertain. First, the traditional framework of maximising health effects with a given health care budget is extended to a flexible budget using a value function over money and health effects. Second, uncertainty surrounding costs and effects is included in the model using expected utility. Other approaches to uncertainty that do not specify a utility function are discussed and it is argued that these also include implicit notions about risk attitude.     

妇幼保健机构人力资源配置对服务开展的影响

目的 分析全国省、市、县三级妇幼保健机构人力资源配置现状、服务开展及医务人员工作负担情况,掌握妇幼保健机构人员配置状况对其服务开展的影响,为政府决策部门合理配置人力资源及制定卫生人力发展规划提供科学依据.方法 2014年中国疾病预防控制中心妇幼保健中心根据《各级妇幼健康服务机构业务部门设置指南》的要求设计调查问卷,在全国抽取了432所妇幼保健机构开展调查.调查妇幼保健机构孕产保健、儿童保健、妇女保健服务开展情况、未开展的原因以及人员配置.结果 省级、市级、县级妇幼保健机构在岗职工总数分别超过原核定编制数的66.3％、45.1％和28.2％.省级妇幼保健机构孕产保健、儿童保健和妇女保健未开展服务项目的比例均超过25％,其中43.6％是由于人员数量不足,13.4％是由于技术水平的限制.市级妇幼保健机构儿童保健服务未开展的比例为45.7％,其中35.2％的原因是由于人员数量不足造成的.县级妇幼保健机构孕产保健、儿童保健、妇女保健服务中未开展服务项目的比例均高于省、市两级机构,人员不足和技术水平受限分别占38.4％和29.2％.三级妇幼保健机构群体保健未开展项目的比例为11％ ～ 13％;三级妇幼保健机构每名医生日均门诊量分别为28.5人次、18.9人次和13.6人次,每医生日均负担住院床日分别为3.2、2.9、1.7床日.结论 各级妇幼保健机构均存在明显的人员编制不足、人员数量和能力不足的情况,工作负担高于综合性医院,影响了妇幼保健机构业务的开展和服务的提供,建议增加妇幼保健机构的人员配备,加强人才队伍建设,改变目前人力严重不足的现状,提高妇幼保健机构服务能力.     

我国医疗卫生服务资源配置公平性研究

目的:探讨当前我国医疗卫生服务资源配置的公平性,为我国深化医药卫生体制改革提供依据。方法:依据2009中国卫生统计年鉴的报道数据,根据地域和经济发展状况随机抽取广东省、上海市、山西省、江西省、贵州省和宁夏回族自治区,选择Gini系数和Lorenz曲线对其医疗卫生服务资源配置的公平性进行评价。结果:我国卫生资源配置的量很大;城市地区每千人口拥有的医生和护士数远高于农村地区,城乡卫生人力资源配置差距很大;东部经济发达地区省市每千人拥有卫生技术人员高于经济欠发达的西部地区省市,卫生人力资源分布存在地区不公平性;城市在病床配置方面显著高于县区,东部经济较发达地区病床使用率比中西部地区高;2008年我国卫生服务在资源配置上已达到较好的公平性,其人均卫生技术人员数和人均床位数均处在最佳的公平状态和正常状态。结论:本研究为我国深化医药卫生体制改革提供了客观依据。     

Access to health care resources in the UK: the case of care for arthritis

The paper uses new and detailed data from a population sample of individuals with arthritis to examine the impact of objective measures of need for treatment and individual measures of socio-economic position on the distribution of public and private health care. The quality of the data and the range of explanatory factors are more detailed than previously used to study of the allocation of NHS care. The results indicate that broadly the NHS appears to meet its equity goal of equal care for equal medical need, though there is evidence that education increases the amount of resources received. The results also show the importance of the interaction between the public and private sectors in the UK.     

分级诊疗实施前后山东省基层医疗卫生资源配置公平性研究

目的 分析分级诊疗实施前后山东省基层医疗卫生资源规模变化及不同经济水平区域之间资源配置公平性变化情况,探究分级诊疗对我省基层卫生资源配置的影响。方法 将分级诊疗实施前后分为两个时间段,对各项卫生资源年均增速进行对比分析,利用集中指数、集中曲线、泰尔指数分析各区域资源配置公平性变化情况。结果 政策实施后,社区卫生服务中心物力、人力资源投入明显增加。村卫生室执业（助理）医师数政策实施后年均增速快约42%;卫生服务利用方面,诊疗人次数下降明显,年均增速降幅平均达5.76%。入院人数方面社区卫生服务中心和乡镇卫生院年均增速比政策实施前分别快10.48%和4.97%;公平性方面,政策实施后集中指数和泰尔指数均减小,但泰尔指数贡献率表明区域间差异超70%,且政策实施后无明显改善。结论 分级诊疗实施对促进基层医疗卫生事业发展成效显著;政策实施后资源配置公平性总体得到改善但区域间差异明显,除床位资源外其他卫生资源配置均倾向于经济发达地区;对农村地区卫生资源投入仍不足。     

山西省卫生资源配置公平性分析

目的:分析2006—2008年、2016—2018年山西省卫生资源的配置现状及公平性,为进一步优化山西省卫生资源配置提供科学依据.方法:使用洛伦兹曲线、基尼系数、泰尔指数对山西省卫生资源的配置及公平性进行评价.结果:山西省卫生资源总量逐年上升,按人口配置的洛伦兹曲线偏离程度更小,2008年和2018年卫生资源按人口和地...     

山东省妇幼保健资源配置现状与公平性分析

[目的]分析2012-2017年山东省妇幼保健资源配置现状及其变化趋势,为进一步优化妇幼保健资源配置提供对策建议。[方法]对2012-2017年山东省妇幼保健资源的相关数据进行描述性统计分析,并采用基尼系数和泰尔指数分析和评价山东省妇幼保健资源配置的公平性。[结果]山东省妇幼保健资源总量呈逐年增长趋势;按人口和按地理配置的基尼系数均在0.3以下;区域内妇幼保健机构、机构床位数、医师数及护士数配置上的差异对总泰尔指数的贡献率远高于区域间差异对总泰尔指数的贡献率。[结论]山东省妇幼保健资源总量稳步增加,按人口和地理配置的公平性较高,区域内差异对妇幼保健资源配置的公平性影响较大。建议卫生行政部门应高度重视,统筹兼顾,进一步优化资源配置,加强人才队伍建设,通过"互联网+医疗健康"信息化平台建设,改善妇幼保健资源配置不公平现状。     

克拉玛依市卫生资源配置现状分析

目的:调查克拉玛依市的卫生资源配置现状,包括财政投入、医疗机构、卫生技术人员和床位以及卫生人力资源配置。方法:通过查阅文献和统计报表以及对医疗机构进行调查的方法获得数据,由Epidata3.0录入,Excel 2007进行统计分析。结果:克拉玛依市的财政投入,每千人口卫生资源占有量达到或超过了全国平均水平,甚至达到发达地区水平,但是其卫生技术人员的水平偏低。结论:克拉玛依市需要在不同行政区域内均衡配置卫生资源,促进公立医院专科化建设,优化人才队伍结构,促进社区卫生的发展以提高和优化卫生资源配置水平。     

卫生资源配置公平性的政策选择

卫生资源配置的公平和高效是世界范围内普遍面临的难题,在我国更表现出复杂性和紧迫性。我国卫生资源配置表现为公平和效率的双缺失,这也正是我国医疗卫生体制改革应着力解决的问题。卫生政策法规对于卫生资源配置具有基础性作用,可对卫生资源配置进行确认、分配和协调。面对我国卫生资源配置的不公平和低效率,应调整卫生政策法规以使得资源配置更加公平、高效。     

广西卫生资源配置公平性分析

目的：对2005—2011年广西卫生资源配置状况及公平性进行分析。方法：采用描述性分析及基尼系数法分析广西不同时期卫生资源配置状况及公平性。结果：2005—2011年广西卫生资源数量呈总体上升的趋势;按人口及按地理面积配置的社区卫生服务中心和卫生事业费的基尼系数总体在0.4以上,其余基尼系数总体小于0.4。结论：当前广西卫生资源已有相当规模。社区卫生服务中心和卫生事业费的公平性较差,其余类别卫生资源公平性合理或较佳。     

Deprivation and mortality: the implications of spatial autocorrelation for health resources allocation

This paper aims at investigating whether the relationship between mortality and socio-economic deprivation is affected by the spatial autocorrelation of ecological data. A simple model is used in which mortality (all-ages and premature) is the dependent variable, and deprivation, morbidity and other socio-economic indicators are the explanatory variables. Deprivation is measured by the Townsend index; the other socio-economic variables are the median income, unequal income distribution (Gini coefficient) and population density. Morbidity is estimated on the basis of hospital admission rates and overweight prevalence. Spatial autocorrelation is measured by the Moran's I coefficient. All mortality and morbidity variables have significant, positive, and moderate-to-high spatial autocorrelation. Two multivariate models are explored: a weighted least-squares model ignoring spatial autocorrelation and a simultaneous autoregressive model. The paper concludes that spatial autocorrelation has a significant impact on the relationship between mortality and socio-economic variables. Future ecological models intended to inform health resources allocation need to pay greater attention to the spatial dimension of the data used.