1991—2011年中国预防医学服务利用趋势及公平性分析

目的:分析1991—2011年间中国居民预防医学服务利用的影响因素、趋势以及公平性。方法:利用中国健康和营养调查(China Health and Nutrition Survey)数据,通过多元logistic回归分析探讨预防服务利用的影响因素;对预防服务利用率随时间变化进行趋势检验;最后借助集中指数进行公平性分析。结果:总预防服务和一般健康检查的利用率随时间逐渐增加,且具有统计学意义。高血压筛查和妇科检查不公平性不再显著,但一般健康检查和查血服务仍然倾向于高收入群体。人均收入、性别、教育程度、医疗保险类型等是影响预防服务利用的主要因素。结论:预防服务利用率显著提升。预防服务利用公平性有所改善,但是不公平性仍然存在,尤其体现在一般健康检查和查血方面。     

2010-2017年我国妇幼保健机构卫生人力资源配置公平性研究

目的探讨我国妇幼保健机构人力资源配置公平性,为各地区妇幼人力资源的优化提供参考依据。方法主要运用洛伦兹曲线、基尼系数及泰尔指数法对我国妇幼保健机构2010-2017年主要人力资源配置的公平性进行评价。结果按人口分布的人力资源基尼系数在0. 14~0. 24之间;按地理分布的人力资源基尼系数在0. 09~0. 56之间,主要是注册护士数、卫生技术人员两项指标均超过警戒线。其中执业(助理)医师配置的公平性最好,卫生技术人员,注册护士的分布公平性相对最差。区域内的泰尔指数大于区域间的泰尔指数,且东部地区的差异对区域内的不公平性的贡献率最大(>40%)。结论妇幼人力资源配置基于人口分布的公平性优于地理分布;不公平主要由地域内差异所致,且东部地区的贡献率较大。     

白银市2003～2008年孕产妇保健服务效果分析

目的:了解白银市孕产妇保健服务状况。方法:对2003~2008年白银市早孕检查率、产前检查率、产后访视率、孕产妇系统管理率、住院分娩率、高危产妇管理率、高危产妇住院分娩率和孕产妇死亡率等进行分析。结果:白银市2003~2008年,孕产妇系统管理率、住院分娩率、新法接生率整体呈上升趋势,平均孕产妇死亡率为53.62/10万。孕产妇保健服务率逐年上升;孕产妇死亡率逐年下降,主要死亡原因为产科出血和内科合并症,住院分娩率与孕产妇死亡率相关性最大。结论:提高孕产妇保健服务,尤其是农村孕产妇系统保健管理率和住院分娩率,对降低孕产妇死亡率具有重要意义。     

2005-2009年我国孕产保健服务资源配置的公平性分析

目的:探讨2005-2009年我国孕产保健服务资源配置的公平性。方法:依据中国卫生统计年鉴中孕产保健服务资源的相关数据,利用基尼系数和泰尔指数分析和评价孕产保健服务资源配置公平性及变动趋势。结果:2005-2009年全国孕产保健服务资源配置处于最佳公平性状态,现有不公平主要来自各地区内部,妇幼保健护士资源配置公平性相对最低。结论:基于现有常规报告资料,我国孕产保健服务资源的区域配置较公平,优化资源配置应关注各地区内部的不公平,并重点考虑护士资源的配置。     

我国妇幼保健资源配置现状及公平性分析

目的了解我国妇幼保健资源配置现状,评价其公平性,为促进我国妇幼保健资源的整体优化提供基本参考。方法以2005-2014年《中国卫生和计划生育年鉴》和《中国统计年鉴》中妇幼保健资源配置的相关指标为原始资料,对我国及各省市的资源配置现状进行描述和分析;同时运用泰尔指数对资源配置的公平性进行评价。结果我国拥有的妇幼保健机构数、医师数、床位数、护士数逐年增加;2005-2014年我国妇幼保健机构、医师数泰尔指数变动较小,床位数、护士数的泰尔指数在0.019 5~0.047 6、0.021 9~0.044 5之间变化,呈增长趋势,且东部地区相对偏高;区域内差异对泰尔指数的贡献率大于区域间,对妇幼保健资源配置的公平性影响较大。结论我国妇幼保健资源总量虽上升,但资源配置不公平,且呈下降趋势,尤其是区域内公平性问题严重,相关部门应重点关注,统筹兼顾,改善妇幼保健资源配置不公平的现状。     

社会剥夺视角下我国妇幼保健机构人员配置公平性研究

目的通过分析评价2015-2017年我国各地区社会剥夺水平,测算各地区妇幼保健机构人员配置的公平性缺口,以期为妇幼保健人力资源的合理配置提供参考。方法在运用主成分分析确定各剥夺指标权重的基础上,采用总体剥夺指数和公平调节构成指数确定各地区社会剥夺水平及应获得的资源比例,以此计算各地区妇幼保健机构所需人数与实际人数的差值明确其公平性缺口。结果 2015-2017年我国各地区总体剥夺指数的取值范围分别为-1. 666～1. 720、-1. 550～1. 808、-1. 613～1. 553,妇幼保健机构人员配置公平性缺口的取值范围分别为-17 904～9 855、-19 627～10 271、-22 093～12 369;人员配置的公平性缺口整体呈现上升趋势,但地区间变化形式不一;总体剥夺指数对地区妇幼保健人员配置公平性缺口值存在正向影响。结论总体上看,我国妇幼保健机构人员配置的公平性较差,应根据各地社会剥夺水平、人口规模、服务需求以及人员专业素质等要素,从加强人员流动、提升服务水平、提高部门协同等方面进行人员合理配置。     

1991-2003年中国农村妇女未住院分娩状况分析

目的 了解1991-2003年我国农村妇女未住院分娩的变化情况以及在家分娩孕产妇的接生人员和费用情况.方法 对3次国家卫生服务调查的相关资料进行分析.结果我国农村妇女的未住院分娩率不断下降,但下降的幅度一、二、三、四类农村差别较大,分别从1991-1993的43.19%、71.72%、76.78%和92.42%下降到2001-2003年的7.17%、17.48%、36.43%和66.80%：农村合计在家分娩的孕妇由受过训练的接生人员接生的比例从1991-1993年的67.51%下降到2001-2003年的51.37%.农村在家分娩费用在50～200元左右.结论 我国农村未住院分娩（主要是在家分娩）的比例在不断减少,但由接受过专门培训的接生员接生的比例在下降,这一情况应引起人们的关注.     

1991-2003年中国农村妇女分娩地点变化趋势

目的 描述1991年以来我国农村妇女分娩地点的变化趋势及在地区与人群间的分布.方法 利用我国3次国家卫生服务调查资料进行描述与分析.结果 我国农村妇女在家分娩的比例从1991-1993年的70.12%下降到2001-2003年的27.52%,住院分娩比例则从1991-1993年的27.30%提高到2001-2003年的68.92%：到县及县以上医院分娩比例上升的速率高于到乡镇卫生院分娩的比例;住院分娩率因年龄、生育史、收入、教育及职业的不同而不同.结论 我国农村妇女的分娩地点逐渐从20世纪90年代初的以家庭分娩为主转向了近年的以住院分娩为主,但部分农村（如四类农村）地区妇女的住院分娩率还未达到《中国妇女发展纲要2000-2010》的要求.因此仍需努力提高农村尤其是落后地区农村妇女的住院分娩率.     

1991～2005年中国孕产妇死亡率变化趋势分析

目的描述1991—2005年中国孕产妇死亡率变化趋势和特征，为有关部门制定孕产妇保健对策提供依据。方法采用描述性分析和升降趋势检验法对1991～2005年我国孕产妇死亡情况进行分析。结果全国、城市和农村的孕产妇死亡率下降幅度明显。1991～2005年全国孕产妇死亡率由80．0／10万降为47．7／10万，下降幅度为40．4％；农村地区孕产妇死亡率由100．0／10万降为53．8／10万，下降幅度为46．2％；城市孕产妇死亡率由46．3／10万降为25．0／10万，下降幅度为46．0％。结论1991—2005年全国及城乡孕产妇死亡率均呈下降趋势，农村孕产妇死亡率显著高于城市，下降空间大，国家应加大农村孕产妇保健的力度。     

Measuring equity in access to health care

This article develops and uses methodologies to: (1) measure equity in the distribution of access to health services; and (2) measure the impact of health insurance programs on equity. The article proposes two egalitarian-based indicators for measuring equity in terms of access to health care--a concentration coefficient derived from the Gini coefficient, and the Atkinson distributional measure and also employs a weighted Utilitarian social welfare function to measure overall levels of access. The article defines access as the use of health care by individuals with a need for care; need is measured as self-reported morbidity. The setting for the empirical application is the country of Ecuador. The Ecuador Social Security Institute runs a General Health Insurance (GHI) program, whose affiliates are primarily workers in the formal sector of the economy. The principal data source is the 1995 Ecuador Living Standards Measurement Survey. The study uses a microeconomic health care demand model and bivariate probit estimation techniques to measure the impact of insurance on health service use for each quintile of adjusted per-capita household expenditure. The study also predicts health care use and program impact for each quintile under a series of simulation scenarios corresponding to proposed expansion of eligibility for the GHI program. The GHI program increases overall access to health care, but has a negative impact on equity in the distribution of health services. The benefits of the program, calculated as its marginal impact on the probability of using of health care, have a strongly regressive distribution. Expanding eligibility to the self-employed makes the benefit more equitably distributed (but still inequitable), and increases overall social welfare considerably. Expanding eligibility to the dependents of the insured person has similar effects, although less important in magnitude.     

中国妇幼卫生人力资源配置现状及公平性分析

目的 了解中国妇幼卫生人力资源配置现状,分析其分布的公平性,为妇幼卫生人力资源相关规划和决策提供参考依据. 方法 抽取全国44个地市中所有提供妇幼医疗保健服务的医疗卫生机构,对2010年妇幼卫生人力资源配置情况进行信函调查,应用洛伦茨曲线和基尼系数评价妇幼卫生人力资源分布的公平性. 结果 2010年中国每万人口拥有妇幼卫生工作人员5.50人,每平方公里拥有妇幼卫生工作人员0.09人.2010年中国妇幼卫生工作人员按人口分布的基尼系数是0.324,按地理面积分布的基尼系数是0.665. 结论 中国妇幼卫生人力资源按人口分布的公平性尚可,但按地理面积分布的公平性较差,妇幼卫生人力资源配置有待进一步调整和改善.     

Challenges to equity in health and health care: a Zimbabwean case study

The current economic crisis in Africa has posed a serious challenge to policies of comprehensive and equitable health care. This paper examines the extent to which the Zimbabwe government has achieved the policy of "Equity in Health" it adopted at independence in 1980, that is provision of health care according to need. The paper identifies groups with the highest level of health needs in terms of both health status and economic factors which increase the risk of ill health. It describes a series of changes within the health sector in support of resource redistribution towards health needs, including a shift in the budget allocation towards preventive care, expansion of rural infrastructures, increased coverage of primary health care, introduction of free health services for those earning below Z$150 a month in 1980, increased manpower deployment in the public sector and the reorientation of medical training towards the health needs of the majority. The implementation of equity policies in health have however been challenged by several trends and features of the health care system, these becoming more pronounced in the economic stagnation period after 1983. These include the reduction in allocations to local authorities, increasing the pressure for fees, the static nominal level of the free health care limit despite inflation, the continued concentration of financial, higher cost manpower and other resources within urban, central and private sector health care and the lack of effective functioning of the referral system, with high cost central quaternary facilities being used as primary or secondary level care by nearby urban residents. While primary health care expansion has clearly been one of the success stories of Zimbabwe's health care post 1980, the paper notes plateauing coverage, with evidence of lack of coverage in more high risk, socio-economically marginal communities. Measures to address these continuing inequalities are discussed. Their implementation is seen to be dependent on increasing the capacity and organisation of the poor to more strongly influence policy and resource distribution in the health sector.     

基于泰尔指数和集中指数的我国妇幼保健资源配置 公平性评价

摘要:目的　分析评价我国妇幼保健资源分布情况及其公平性。方法　主要利用集中指数、集中曲线和泰尔指数进行测算。结果　妇幼保健机构数、妇幼保健机构床位数、妇幼保健机构卫生技术人员数的集中指数CI分别为:-0.108 0、0.118 8、0.172 4,表明我国妇幼保健资源的配置向经济水平较高的地区倾斜较为明显,地区之间妇幼保健资源配置不公平。泰尔指数显示,我国妇幼保健资源地区间仍存在配置差距。各地区内部配置不公平性较为严重,是影响我国妇幼保健资源配置公平性的主要因素。结论　妇幼保健资源配置不合理,妇幼保健资源中机构数、床位数的公平性优于卫生技术人员数的公平性;妇幼保健资源配置地区间较为公平,优化妇幼保健资源配置应重点关注地区内部的不公平,尤其是东部地区;妇幼保健资源配置城乡差异显著,农村地区优于城市地区。     

Socioeconomic patterns in the use of public and private health services and equity in health care

Background  

Several studies in wealthy countries suggest that utilization of GP and hospital services, after adjusting for health care need, is equitable or pro-poor, whereas specialist care tends to favour the better off. Horizontal equity in these studies has not been evaluated appropriately, since the use of healthcare services is analysed without distinguishing between public and private services. The purpose of this study is to estimate the relation between socioeconomic position and health services use to determine whether the findings are compatible with the attainment of horizontal equity: equal use of public healthcare services for equal need.     

2003-2018年兰州市孕产妇死亡率变化及保健状况主成分分析

目的 分析兰州市2003-2018年孕产妇死亡率变化和孕产妇保健状况,为兰州市妇女保健工作提供依据.方法 采用动态数列和Mann-Kendall趋势检验分析兰州市2003-2018年孕产妇死亡率变化趋势和孕产妇保健状况,运用主成分分析综合评价2003-2018年孕产妇保健状况.结果 兰州市2003-2018年孕产妇死亡...     

Why equity in health and in access to health care are elusive: Insights from Canada and South Africa

Health and access to health care vary strikingly across the globe, and debates about this have been pervasive and controversial. Some comparative data in Canada and South Africa illustrate the complexity of achieving greater equity anywhere, even in a wealthy country like Canada. Potential bi-directional lessons relevant both to local and global public health are identified. Both countries should consider the implications of lost opportunity costs associated with lack of explicit resource allocation policies. While National Health Insurance is attractive politically, Canada's example cannot be fully emulated in South Africa. Short- and medium-term attempts to improve equity in middle-income countries should focus on equitable access to insurance to cover primary health care and on making more use of nurse practitioners and community health workers. In the longer-term, attention is needed to the economic and political power structures that influence health and health care and that ignore the social and societal determinants of sustainable good health locally and globally. This long-term vision of health is needed globally to achieve improvements in individual and population health in a century characterised by limits to economic growth, widening disparities, continuing conflict and migration on a large scale and multiple adverse impacts of climate change.