中国全科医生发展趋势及公平性研究

背景　全科医生被誉为居民健康的“守门人”。大力培养全科医生、落实基层首诊和推进分级诊疗是当前医改的重点工作之一。目前，用近期数据对全科医生资源配置公平性进行的研究相对较少。目的　分析我国全科医生资源配置的现状，探讨其发展趋势及公平性。方法　以2013-2018年中国统计年鉴和中国卫生与计划生育统计年鉴（中国卫生健康统计年鉴）为资料来源，描述我国全科医生资源配置的基本情况，运用洛伦茨曲线、基尼系数、泰尔指数，从人口、地理面积、经济3个维度分析我国全科医生资源配置的公平性。结果　2012-2017年我国全科医生数由109 794人增长至252 712人，年均增长率为18.14%。2012年和2017年我国全科医生按人口分布的基尼系数分别为0.31和0.26，按经济分布的基尼系数分别为0.25和0.18，按地理面积分布的基尼系数分别为0.74和0.72。泰尔指数分析的结果为组内差异大于组间差异。其中，按人口和经济分布的不公平性主要来源于高人均国内生产总值（GDP）组，按地理面积分布的不公平性主要来源于低人均GDP组。结论　我国全科医生队伍建设发展迅速，但仍存在资源配置总量不足和区域发展不均衡的问题。全科医生按人口、经济配置的公平性优于按地理面积配置的公平性。经济因素对我国全科医生配置公平性影响较大。

The Development Trend and Allocation Equity of General Practitioners in China

Background General practitioners are"gatekeepers"of residents'health.It is one of the key tasks of current medical reform to vigorously train general practitioners and carry out the initial diagnosis and treatment of family doctors at the grassroots level and to promote hierarchical diagnosis and treatment.At present,there is a lack of research on the equity of allocation of general practitioners with recent data.Objective To analyze the current situation of allocation of general practitioners in China,in order to explore its development trend and equity.Methods Data from the China Statistical Yearbook 2013—2018 and China Health and Family Planning Statistical Yearbook(China Health Statistics Year Book)2013—2018 were used to describe statistically the basic situation of allocation of general practitioners in China.The resource allocation equity of general practitioners was measured from the aspects of the population,geographical area and economic development using Lorenz curve,Gini coefficient and Theil index.Results From 2012 to 2017,the number of general practitioners in China increased from 109794 to 252712,with an average annual growth rate of 18.14%.In 2012 and 2017,the Gini coefficients of Chinese general practitioners based on population distribution were 0.31 and 0.26,based on economic development were 0.25 and 0.18,and based on geographic area were 0.74 and 0.72.The results of Theil index analysis showed that the intra-group difference was greater than the inter-group difference.Among them,the iniquity of population and economic distribution mainly came from the high per capita gross domestic product(GDP)group,and the iniquity of the distribution according to the geographical area mainly came from the low per capita GDP group.Conclusion The construction of general practitioner team in China has developed rapidly,but there are still problems of insufficient resource and the uneven regional development.The allocation of general practitioners according to population distribution and economic development is fairly fair,while the allocation equity according to geographical area is in an unfair state.Economic factors have a great impact on the allocation equity of general practitioners in China.