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。

Equity of primary medical and health resources allocation before and after Hierarchical medical system,Shandong

e To analyze the changes in the scale of primary medical and health resources in Shandong Province beforeand after the implementation of hierarchical diagnosis and treatment and the fairness of resource allocation among regions withdifferent economic levels，and to explore the impact of hierarchical diagnosis and treatment on the allocation of primary healthresources. Methods Before and after the implementation of hierarchical diagnosis and treatment was divided into two timeperiods，and the average annual growth rate of various health resources was compared and analyzed，and the changes of regionalresource allocation equity were analyzed by concentration index，concentration curve and Theil index. Ｒesults After theimplementation of the policy，the input of material and human resources in community health service centers had increasedsignificantly. After the implementation of the policy on the number of practicing ( assistant) physicians in village clinics，theaverage annual growth rate was about 42%. In terms of health service utilization，the number of diagnosis and treatments haddropped significantly，with the average annual growth rate dropping by 5. 76%. From the perspective of the number of hospitaladmissions，the average annual growth rates of community health service centers and township health centers were 10. 48% and4. 97% respectively faster than before the implementation of the policy. Addition to fairness，both the concentration index andthe Theil index had decreased after the implementation of the policy，but the contribution rate of the Theil index showed that theregional difference had been over 70% ，and there was no obvious improvement after the policy implementation. ConclusionThe implementation of hierarchical diagnosis and treatment has achieved significant results in promoting the development ofprimary medical and health services. After the implementation of the policy，the fairness of resource allocation has beenimproved overall but the regional differences are obvious. The allocation of other health resources except for bed resources tendsto be in economically developed areas. Moreover，health resource input in rural area is still insufficient.