公共管理论文
摘要
目的 本文通过分析 2011-2014 年青海省的卫生资源配置现状，评价卫生资源配置的公平性，来了解青海省当前卫生资源配置中存在的问题，从而为卫生资源进行优化配置，为提高卫生资源配置的公平性提出合理化的建议，并为当地政府和有关部门制定区域卫生规划提供政策性的参考，更好的为提高人民群众的健康服务，进而促进青海省的卫生事业向着协调、持续的方向发展。
方法 本文的研究方法包括文献检索、描述性分析、定量研究方法等。青海省的社会经济概况以及卫生资源配置现状分析，主要运用了文献研究、描述性分析方法; 青海省卫生资源配置的公平性，主要运用了经济学方法，即洛伦兹曲线、基尼系数、泰尔指数; 通过定量研究，分析了青海省 2011-2014 年卫生资源配置的人口分布公平性与地理分布公平性，以及区域间与区域内的差异。
结果
1.青海省卫生资源配置现状
（1）卫生人力资源各指标呈稳步增长状态：2011-2014 年青海省的卫生人力资源呈逐年上升的趋势，其中卫生人员数从 2011 年的 31036 人增长到 2014 年的38673 人，年平均增长率为 6.15%，卫生技术人员从 2011 年的 26132 增长到 2014年的33138人，年平均增长率为6.70%，注册护士从2011年的 9368人增长到2014年的 12961 人，年平均增长率为 9.56%，执业（助理）医师数从 2011 年到 2013年逐渐增长，2014 年有所下降，由 12069 人下降到 11960 人，四年平均增长率为 4.82%。
（2）卫生物力资源呈逐年上升的趋势：青海省医疗机构数从 2011 年的 5890个增加到 2014 年的 6241 个，增加了 351 个，其中医院、基层卫生机构、公共卫生机构等都有一定数量的增加。医疗机构床位数从2011年的23171张增加到2014年的 33107 张，增加了近一万张床位。2011-2014 年青海省每千人口床位数呈逐年上升的趋势，由 4.18 张增长到 5.71 张，与全国同期水平相比较均高一些，但是与一些发达城市的每千人口床位数相比，则仍有较大差距。
（3）青海省卫生总费用不断增长，但人均费用低于全国水平：青海省卫生总费用从 2011 年的 561573.30 万元增长到 2014 年的 952546.50 万元，增长了390973.2 万元，人均卫生费用呈逐年上升的趋势，从 2011 年的人均 1007.15 元增长到了 2014 年的人均 1641.86 元，但与全国水平相比仍有一定的差距。青海省各地区之间卫生机构收入与支出不均衡，存在着很大差距。
2.青海省卫生资源配置的公平性
（1）基尼系数分析青海省卫生资源配置的公平性青海省卫生资源按照人口分布的公平性相对较好：洛伦兹曲线绘制出的弯曲程度较小，与绝对公平线较近，卫生人力资源的基尼系数小于 0.4，说明卫生人力资源按照人口分布处于正常的状态。医疗机构床位数按照人口分布的公平性也相对较好，洛伦兹曲线绘制出的弯曲程度较小，与绝对公平线较近，基尼系数小于 0.3，表明处于最佳的平均状态。
青海省卫生资源按照地理分布的公平性相对较差：洛伦兹曲线其弯曲程度较大，偏离绝对公平线，卫生资源的基尼系数均处于 0.6-0.8 之间，说明卫生人力资源按照地理分布处于高危的绝对不公平状态。
（2）泰尔指数分析青海省卫生资源配置的公平性卫生人力资源的总泰尔指数相对较小，其中注册护士的泰尔指数相对其他指标较高一些。将总泰尔指数分解，区域间贡献率大，区域内贡献率较小，则可以说明卫生人力资源的配置是不均衡的，并且主要原因在于各类地区间存在的差异。医疗机构床位数的总泰尔指数也较小，将总泰尔指数分解后得到区域间贡献率大，区域内贡献率小，说明床位数的配置也是不平衡的，造成不公平的主要原因在于各类地区间存在的差异。
结论（1）青海省卫生资源总量基本足够，并呈持续增长状态，但资源分布不均衡。（2） 青海省卫生资源配置的人口公平性明显优于地理公平性, 各项卫生资源按人口分布的基尼系数处于较好的平均状态，而地理公平性均超过了警戒状态，表现出高度不公平性。（3）青海省卫生资源配置总体上处于比较公平的状态，区域间差异是造成青海省卫生资源配置不均衡的主要原因。（4） 青海省护理人力资源总量不足，医护比远低于国家 1:2 的标准。护理人员的长期缺乏是影响青海省医疗保障水平的关键因素。
关键词：青海省，卫生资源配置，现状，公平性
Abstract
Objective: To identify the existing problems in the current allocation of healthresources in Qinghai Province according to the analysis on the status and equity ofallocation of health resources in Qinghai Province from 2011 to 2014. In addition tothe optimal allocation of health resources, the reasonable suggestions are alsoproposed to improve the equity of allocation of health resources and the policyreferences are provided for the local government and departments concerned toprepare the regional health planning, which can improve the health of people and thusdrive the development of health service in Qinghai Province to the coordinated andsustainable direction.
Methods: The research methods in this paper included the document retrieval,descriptive analysis and quantitative research. The document retrieval and descriptiveanalysis were employed to introduce the social and economic situation and analyzethe status of allocation of health resources in Qinghai Province; the economicmethods, namely Lorenz curve, Gini coefficient and Theil index, were adopted toevaluate the equity of allocation of health resources in Qinghai Province; and thequantitative research was used to analyze the equity of allocation of health resourcesregarding the population distribution and geographical distribution and the differencebetween regions in Qinghai Province from 2011 to 2014.
Results:
1. Status ofAllocation of Health Resources in Qinghai Province(1) The indexes of human resources for health were increased steadily: the humanresources for health in Qinghai Province were increased year by year from 2011 to2014, where the number of health personnel was increased from 31,036 in 2011 to38,673 in 2014, with the annual growth rate of 6.15%; the number of healthprofessionals from 26,132 in 2011 to 33,138 in 2014, with the annual growth rate of6.70%; the number of registered nurses from 9,368 in 2011 to 12,961 in 2014, withthe annual growth rate of 9.56%; the number of practicing (assistant) physicians wasgradually increased from 2011 to 2013, but a bit decreased in 2014 from 12,069 to11,960, with the annual growth rate of 4.82% in four years.
(2) The material resources for health were increased year by year: The number ofmedical institutions was increased by 351 from 5,890 in 2011 to 6,241 in 2014, wherethe number of hospitals, grass-root health facilities and public health facilities werealso increased . The number of beds in medical institutions was increased by nearly10,000 from 23,171 in 2011 to 33,107 in 2014. The number of beds per 1000population was increased from 4.18 in 2011 to 5.71 in 2014 in Qinghai Province,which was a bit higher than the national level over the same period. But there was thelarge gap compared with the one in some developed cities.
(3) The total health expenditure was gradually increased in Qinghai Province, butthe expenditure per person was lower than the national level: The total healthexpenditure was increased by RMB 39.09732 million Yuan from RMB 561.57330million Yuan in 2011 to RMB 952.54650 million Yuan in 2014 in Qinghai Province;while the expenditure per person was increased year by year from RMB 1007.15 Yuanin 2011 to RMB 1641.86 Yuan in 2014, but there was the certain gap compared withthe national level. There was the significant difference in the income and expenditureof medical institutions among regions in Qinghai Province.
2. Equity of Allocation of Health Resources in Qinghai Province(1) Analysis on Equity of Allocation of Health Resources in Qinghai Provinceusing Gini Coefficient
The equity of allocation of health resources regarding the population distributionin Qinghai Province was relatively good: The curvature of Lorenz curve was smalland it was close to the absolute equity line. The Gini coefficient of human resourcesfor health was less than 0.4, which indicated that the human resources for health wasin the normal state regarding the population distribution. The equity of the number ofbeds in the medical institutions regarding the population distribution was relativelygood. Where, the curvature of Lorenz curve was small and it was close to the absoluteequity line. Its Gini coefficient was less than 0.3, which indicated that it was in theoptimal average state.
The equity of allocation of health resources regarding the geographicaldistribution in Qinghai Province was relatively poor: The curvature of Lorenz curvewas large and it was deviated from the absolute equity line. The Gini coefficient ofhealth resources was between 0.6-0.8, which indicated that the human resources forhealth regarding the geographical distribution was in the dangerous state of absoluteinequity state.
(2) Analysis on Equity of Allocation of Health Resources in Qinghai Provinceusing Theil Index
The total Theil index of human resources for health was relatively small, wherethe Theil index of registered nurse was higher than other indexes. By decomposingthe total Theil index, the inter-regional contribution rate was large and theintra-regional contribution rate was small, which indicated that the allocation ofhuman resources for health was unbalanced, with the main reason of differenceamong regions. The total Theil index of the number of beds in medical institutionswas also small. By decomposing the total Theil index, the inter-regional contributionrate was large and the intra-regional contribution rate was small, which indicated thatthe allocation of the number of beds was also unbalanced, with the main reason ofdifference among regions.
Conclusion: (1) The total amount of health resources in Qinghai Province isbasically sufficient and shows the trend of constantly increasing. But the allocation ofresources is unbalanced. (2) The population equity of allocation of health resources inQinghai Province is significantly better than the geographical one. The Ginicoefficient of health resources regarding the population distribution is in the goodaverage state, while the geographical equity exceeds the risk level, showing the highinequity. (3) The allocation of health resources in Qinghai Province is in the state ofequity as a whole. The difference among regions is the main reason for theunbalanced allocation of health resources in Qinghai Province. (4) The total amountof human resources for nursing in Qinghai Province is insufficient and its ratio ofphysicians and nurses is far lower than the national level of 1:2. The long-term lack ofnursing personnel is the key factor to affect the level of medical security in QinghaiProvince.
Keywords: Qinghai Province; Allocation of Health Resources; Status; Equity
目 录
中文摘要
Abstract
1 前言
1.1 研究背景
1.2 国内外研究现状
1.3 目的意义
2 研究内容与方法
2.1 研究内容与资料来源
2.2 研究方法
2.3 技术路线
3 青海省社会经济发展概况
3.1 经济社会发展概况
3.2 人群健康水平
4 青海省卫生资源配置情况
4.1 卫生人力资源配置
4.2 卫生物力资源配置
4.3 卫生费用资源配置
5 青海省卫生资源配置的公平性分析
5.1 基于洛仑兹曲线及基尼系数的公平性分析
5.2 基于泰尔指数的公平性分析
6 讨论
7 结论与建议
参考文献
致 谢