基于基尼系数和集聚度的上海市卫生资源配置公平性分析

目的分析2017年上海市卫生资源配置情况及其公平性和变化趋势,探索优化卫生资源配置的措施和途径。方法基于基尼系数和集聚度的方法对主要卫生资源进行评价,分析上海市整体和区域间资源配置的公平性和集聚度。结果各类医疗卫生资源的基尼系数按人口分布均在0.4以内,而按地理面积分布的基尼系数都在0.55以上。黄浦区等9大区域的各卫生资源的聚集度均大于1,其余区县的集聚度均小于1。黄浦区、徐汇区、长宁区、静安区各类卫生资源集聚度与人口集聚度的比值均大于1;而虹口区、杨浦区机构数聚集度与人口集聚度比值小于1,其余各类卫生资源集聚度与人口集聚度比值均大于1;金山区、青浦区、奉贤区、崇明区的机构数与人口集聚的比值大于1。结论按人口分布,公立医疗机构的数量、床位和护理人员在各区域分布不公平;按地理分布,各项指标均出于极度不公平状态,卫生资源配置存在在区域集聚。

Analysis on Equity of Health Resource Allocation in Shanghai based on Gini Coefficient and Agglomeration Degree

Objective:To analyze the allocation of health resources in Shanghai in 2017,its equity and change trend,and explore the measures and approaches to optimize the allocation of health resources.Method:The main health resources were evaluated,based on the methods of Gini coefficient and agglomeration degree for the further analysis on the fairness and agglomeration degree of the overall and inter-regional resource allocation in Shanghai.Result:The Gini coefficient of all kinds of medical and health resources is less than 0.4 according to population,while the Gini coefficient of all kinds of medical and health resources is more than 0.55 according to geographical area.The agglomeration degree of health resources in 9 areas such as Huangpu District is greater than 1,and the agglomeration degree of other districts and counties is all less than 1.The ratio of health resource agglomeration degree to population agglomeration degree in Huangpu District,Xuhui District,Changning District and Jing’an District is all greater than 1.In Hongkou and Yangpu districts,the ratio of institution concentration degree to population concentration degree is less than 1,and the ratio of other kinds of health resource concentration degree to population concentration degree is more than 1.The ratio of the number of institutions to population concentration in Jinshan District,Qingpu District,Fengxian District and Chongming District is greater than 1.Conclusion:According to the distribution of population,the number of public medical institutions,beds and nursing staff are not equally distributed in different regions.In terms of geographical distribution,all indicators are in a state of extreme inequality,and the allocation of health resources is concentrated in regions.