基层医疗卫生人力配置及公平性实证分析

目的:分析基层卫生综合改革重点联系点34个区县基层卫生人力配置及公平性。方法:利用重点联系区县2013-2015年的卫生计生统计年报表数据,采用千人口(万人口)卫生人力反映其配置水平,计算各类基层卫生人力基尼系数和泰尔指数反映其公平性,利用泰尔指数分解法分析区域内和区域间因素对总体不公平的贡献。结果:2015年,重点联系区县基层千人口卫生人员、执业(助理)医师和注册护士数分别为1.44人、0.52人和0.40人,万人口全科医生数为2.43人,与2013年相比,千人口执业(助理)医师数减少,万人口全科医生数增加明显,东部地区基层卫生人力配置高于中西部。2015年,卫生人员、执业(助理)医师、全科医生和注册护士的基尼系数分别为0.170 7、0.192 0、0.354 2和0.187 3,泰尔系数分别为0.019 9、0.026 2、0.132 2和0.031 4,除全科医生外的其他基层卫生人力配置较为公平,与2013年相比,执业(助理)医师和全科医生公平性趋好。基层卫生人力在区域间的配置差异对总泰尔指数的贡献率均在15%左右,区域内部占85%左右,其中,东部地区内部配置差异对总泰尔指数的贡献率约60%。结论:重点联系区县基层卫生人力配置不公平主要来自区域内部,尤其是东部地区;基层卫生人力配置仍显不足,全科医生队伍建设亟待进一步加强。

Analysis of the operating Efficiency of Basic Healthcare Facilities of Areas of primary health care comprehensive reform

Objective: To analyze the allocation and equity of primary health human resources in 34 key contact districts/counties of primary health comprehensive reform. Methods: The number of health personnel per 1000 people (the number of general practitioners per 10,000 people) was calculated to describe the allocation of primary health human resources; the Gini coefficient and the index of Taylor were calculated to reflect the equity; and the Theil index decomposition method was used to understand the contributions of interregional and intraregional difference of human resources allocation in primary health care, based on the data of 2013 - 2015 Health and Family Planning Statistical Yearbook. Results: The number of health personnel, practice (assistant) physicians and registered nurses per 1000 people in key contact districts/counties w ere relatively 1.44, 0.52, 0.40, and the number of general practitioners per 10,000 people were 2.43 in 2015, Compared with 2013, the number of practice (assistant) physician per 1000 people decreased, and the number of general practitioners per 10 000 people increased significantly and the allocation of primary health human resources in the east was better than that in the central and western regions. In 2015, the Gini coefficients of health personnel, practice (assistant) physicians, general practitioners and registered nurses were respectively 0.1707, 0.1920, 0.3542 and 0.1873; the index of Taylor were respectively 0.0199, 0.0262, 0.1322 and 0.0314. The allocation of primary health human resources was relatively equitable except for general practitioners. The equity of practice (assistant) physicians and general practitioners was improved compared with that in 2013. The interregional difference of primary health human resources allocation contributed 15% to the total Theil index. The other 85% w as from the intraregional difference, with the eastern region having the greatest influence on the total difference, contributing 60% to the total Theil index. Conclusion The inequity of primary health human resources allocation in key contact districts/counties was mainly due to intraregional difference, especially in the eastern region. There was a lack of primary health human resources, The construction of general practitioner teams needed to be further strengthened