KMS XINJIANG INSTITUTE OF ECOLOGY AND GEOGRAPHY，CAS
| 昌吉市医疗卫生资源优化配置研究 | |
| 程兰花 | |
| Subtype | 硕士 |
| Thesis Advisor | 杨德刚 |
| 2018-06-01 | |
| Degree Grantor | 中国科学院大学 |
| Place of Conferral | 新疆乌鲁木齐 |
| Degree Discipline | 理学硕士 |
| Keyword | 医疗卫生资源配置 效率 公平性 空间布局 昌吉市 Medical and health resource allocation Efficiency Fairness Space layout Changji |
| Abstract | 处于社会经济发展转型重要时期的我国正逐渐由生存型社会向发展型社会过渡。现阶段，地方公共服务供应能力的有限性与居民日益多元化、高质量的公共服务需求间往往存有矛盾。“公共服务均等化”是 2005 年中共十六届五中全会提出的重要理论命题。中国共产党第十九次全国代表大会报告也提出到 2035 年，我国将基本实现基本公共服务均等化。公共服务资源作为公共服务的物质载体，其公平有效配置是贯彻公共服务均等化、保证社会公平的必由路径和重要体现。医疗卫生资源作为公共服务资源的重要构成部分，研究其优化配置对实现基本医疗卫生服务均等化意义重大。昌吉市是处于我国西北地区的新疆维吾尔自治区的一座中小城市，目前存在有医疗卫生资源供需矛盾现状，研究该市的医疗卫生资源优化配置问题不仅有利于促进昌吉市医疗卫生资源的有效合理利用、推动全市基本医疗卫生服务均等化的落实，还可以弥补目前国内关于公共服务资源配置研究多集中在东部经济较为发达的大城市而缺乏中西部地区中小城市的相关研究的不足。本文首先对国内外关于医疗卫生资源配置的研究进行归纳、整理和总结，进而针对医疗卫生资源配置研究存在的学科融合不足、研究体系不完善，缺乏综合性和小尺度研究等问题，以昌吉市作为研究对象，综合运用数据包络分析（DEA）法、基尼系数、洛伦兹曲线、泰尔指数、灰色预测模型 GM（1,1）、缓冲区分析法、基于最小阻抗的可达性分析法，分别从医疗卫生资源配置效率、医疗卫生资源量配置公平性以及医疗卫生机构空间布局合理性三个方面对昌吉市医疗卫生配置状况进行评价和优化分析。研究发现：(一） 2011-2016 年昌吉市总体医疗卫生资源配置效率呈下降态势，其配置效率下降主要是由技术进步的无效变动造成的，配置组织管理水平保持较稳定状态，主要是由规模经济改善推动的；各辖区平均配置综合效率相对较高，但差距较大；各级医疗卫生机构中市区医院（一级）、社区卫生服务站和村卫生室（三级）的配置综合效率较低，社区卫生服务中心和乡镇卫生院（二级）的配置综合效率较高。利用 DEA 方法对昌吉市总体、各辖区、各级医疗卫生机构的医疗卫生资源配置效率评价和优化分析具有诸多优点，评价结果能为昌吉市卫生系统效率诊断、整体评估及医疗卫生资源存量调整提供总的方向和依据，但得出的效率值仅是相对效率而非绝对效率。在医疗卫生资源配置实际决策和规划过程中，不能过度依赖 DEA 评价结果，应坚持定性与定量相结合，并且具体问题具体分析。（二）昌吉市医疗卫生的财、人、物资源量配置中除医生数配置比较平均外，其余医疗卫生资源量配置差距均较大，其中医疗卫生支出差距较大主要是由街道办事处与乡镇的组间差异较大引起，其余医疗卫生资源量配置差距较大主要是由街道办事处组内差异较大引起。未来昌吉市各辖区人口总量和出生人口总量将有增有减，总量之和将呈增长趋势； 60 岁以上人口均呈增长趋势。未来医疗卫生资源需求量较多的区域主要集中在北京南路办事处、绿洲路办事处、建国路办事处、延安北路办事处、中山路办事处和三工镇。按常住人口计算的各类医疗卫生资源需求量均高于按户籍人口计算的需求量，且差距越来越大。预计到 2025 年按常住人口计算昌吉市总体医疗卫生资源用地面积、医疗卫生人员数、医生数、医疗卫生床位数需求量将达到 542607.41 平方米、 5942 人、 2035 人、 4816 张，将比现状配置分别多 258153.17 平方米、 3617 人、 1256 人、 2067 张。（三）昌吉市目前已基本形成了市、乡、村三级医疗卫生服务体系，市区医院多集中于城区中心位置；每个街道均设有 1 个社区卫生服务中心，每个乡镇均设有 1 个乡镇卫生院；大部分的社区和村庄已分别设有社区卫生服务站和村卫生室。基于缓冲区的昌吉市医疗卫生机构空间可达性分析可知：在不考虑医疗卫生机构层级且居民均选择以步行方式就医的情况下，为减少医疗卫生资源的浪费，昌吉市未来仅需在 9 个无法在 20 分钟内步行到达任何医疗卫生机构的村庄（社区）设置村卫生室（社区卫生服务站）；在不考虑医疗卫生机构层级且居民均选择以车行方式就医的情况下，昌吉市医疗卫生机构空间布局较为合理，能较好地满足居民的医疗服务需求；在考虑医疗卫生机构层级及居民就医方式偏好的情况下，为进一步落实国家分级诊疗制度和避免医疗卫生资源的浪费，昌吉市未来应在 35 个无法在步行 20 分钟内到达任何三级医疗卫生机构的村庄（社区）设置村卫生室（社区卫生服务站）， 8 个已设置有三级医疗卫生机构但无法在车行 20 分钟内到达最近乡镇级及以上医疗卫生机构的村庄（社区），根据其空间分布位置并结合城镇用地和农村居民点用地分布情况，建议提高阿克旗村的医疗卫生资源配置级别，改善庙尔沟村、板房沟村与硫磺沟镇卫生院之间的交通基础设施，提高该段路程的车行速度。基于最小阻抗的昌吉市医疗卫生机构空间可达性分析可知：各村庄（社区）点到乡镇级及以上医疗卫生机构的可达性具有明显的空间差异性和空间规律性，表现为可达性以城区为中心向外递减，靠近城区、沿公路及近乡镇中心的较高，离市区较远、处于各乡镇边缘的较低；各辖区到乡镇级及以上医疗卫生机构的可达性水平分化较为严重，表现为街道办事处间差异较小，街道办事处与乡镇间差异较大，乡镇与乡镇间也具有明显差异。 |
| Other Abstract | China is having a transition from a survival society to a developmental one beingin an important period of transformation of social and economic development. Atpresent, the limitation of local public service supply capacity is often contradictorywith the increasing diversified and high-quality public service demands. ”Equalizationof public services” is an important theoretical proposition put forward by the fifthplenary session of the 16th CPC central committee in 2005. The 19th NationalCongress of the communist party of China has also proposed that China will basicallyequalize basic public services in 2035. As the material carriers of public service,public service resources are allocated fairly and effectively, which is the only path andthe most important embodiment to achieve the public service equality and ensuresocial justice. It is of great significance to study the optimal allocation of medical andhealth resources as an important part of public service resources to realize theequalization of basic medical and health services. Changji is a small andmedium-sized city in northwestern of China, where a contradiction is between supplyand demand of health resource. The research about optimal allocation of medical andhealth resources of Changji is not only beneficial to promote the effective utilizationmedical and health resources and ensure the implementation of the basic publicservice equalization of the city, but also can make up for the current domestic researchon resource allocation of public service more concentrated in the more developedeastern cities and the lack of related research about small and medium-sized cities inthe central and western regions. This paper firstly summarizes the research on theallocation of medical and health resources at home and abroad. In this way, theresearch on medical and health resource allocation research is not fully integrated, theresearch system is not perfect, and there is a lack of comprehensive and small scaleresearch. Changji as the research object in this paper that using Data EnvelopmentAnalysis, Gini, Lorentz Curve, Thiel, Grey Predication Model, Buffer Analysis,Accessibility Analysis Based on Minimum Impedance comprehensivly to evaluateand optimize the medical and health configuration of changji from three aspects,namely, the allocation efficiency of medical and health resources, the fairness ofmedical and health resource allocation, and the rationality of the spatial distribution ofmedical and health institutions. Research findings:First, the efficiency of medical and health resources allocation of whole changjiwas holistically decreased during 2011 to 2016, and which is mainly caused byinvalid changes in technological progress. Management level of configurationorganization keeps the stable state, which is mainly driven by improving economies inscale. The average allocation efficiency of each jurisdiction is relatively high, but thegap is bigger. The allocation efficiency of urban hospitals (level 1), community healthservice station and village health room (level 3) is relatively low, and the allocationefficiency of community health service center and township health center (level 2) isrelatively high. Using DEA method has many advantages for the evaluation andoptimization of the medical and health resource allocation efficiency of the medicaland health institutions in changji city, each district and at all levels. The evaluationresult can provide the general direction and basis for the efficiency diagnosis, overallevaluation and the inventory adjustment of medical and health resources in changjicity, but the efficiency value obtained is only relative efficiency rather than absoluteefficiency. In the actual decision-making and planning process of medical and healthresource allocation, it should not to be over-dependent on the results of DEAevaluation,should be adhered to combination of qualitative and quantitative analysis,and should analyze specific problems.Second, in addition to the number of doctors, the quantity disparity of workers,goods and content of medical and health resources is larger in changji. The larger gapof medical and health expenditure mainly caused by differences between groups ofstreet offices and towns, the rest of the medical and health resources allocationquantity larger gap is mainly caused by the differences in the group of street offices.In the future, there will be an increase or decrease of total population and the births ofthe districts of changji, but the sum will be increasing. The population above 60 years old of districts shows an increasing trend. The demand for medical and healthresources more areas are mainly concentrated in the south road of Beijing office, theoffice of the oasis road, jianguo road, yanan north road, zhongshan road and threeindustrial town in the future. The demand for medical and health resources accordingto the resident population is higher than the demand of the registered population, andthe gap is increasing. In 2025, being calculated on the population of permanentresidents, the demand of land used for medical and health resources, health careworkers, doctors and beds of the overall Changji will reach 542607.41m2, 5942people, 2035 people, 5942 pieces, more 258153.17m2, 3617 people, 1256 people,3617 copies than current configuration.Third, changji city has basically formed the three-level medical and health servicesystem of city, township and village, and urban hospitals are mainly concentrated inthe central location of urban areas. There is a community health service centre in eachstreet, with one township health centre in each town. Most communities and villageshave community health service stations and village clinics. The space analysis aboutaccessibility of medical and health institutions based on buffer shows: withoutconsidering medical institutions level and the residents are choose by foot under thecondition of medical treatment, in order to reduce the waste of medical resources,Changji only set up the village clinic (community health service stations)in ninevillage (community) that can not arrive any medical and health institutions by 20minutes walk in the future; Without considering medical institutions level and theresidents are choose in garage way under the condition of medical treatment, thespace layout of medical institutions in Changji is reasonable, can well meet thedemand of medical services of residents; Considering medical institutions level andresidents preferences, in order to further implement the hierarchical medical systemand avoid the waste of medical resources,Changji in the future should set up thevillage clinic (community health service stations) in 35 villages (communities) whichare unable to reach any level 3 medical institutions within 20 minutes' walk, eightvillages (communities), which has set the three levels of medical institutions but notreach township-level and above medical and health institutions within 20 minutes buffer, should have some adjustments according to their spatial location and thedistribution of the land for urban and rural residential areas. It is suggested that weraise the level of the allocation of the arkflag village in health and health resources,and improve the transportation infrastructure between the health hospitals ofMiaoErGou village, BanFangGou village and LiuHuangGou village in order toincrease the car speed for this journey. The space analysis about accessibility ofmedical and health institutions based on the minimum impedance shows: theaccessibility of the village (community) to the township-level and above medical andhealth institutions has obvious spatial heterogeneity and spatial regularity, showingthat the city center is decreasing outwards, being close to downtown area, along thehighway and near the center of the town are higher and being far away from the urbanarea and at the edge of each town are lower; the accessibilities of jurisdictions totownship-level and above medical and health institutions have a seriousdifferentiation, showing that the difference between the street office is small, thedifference between the street office and the town is large, and there are also obviousdifferences between town and town. |
| Subject Area | 人文地理学 |
| Language | 中文 |
| Document Type | 学位论文 |
| Identifier | http://ir.xjlas.org/handle/365004/14960 |
| Collection | 研究系统_荒漠环境研究室 |
| Affiliation | 中国科学院新疆生态与地理研究所 |
| First Author Affilication | 中国科学院新疆生态与地理研究所 |
| Recommended Citation GB/T 7714 | 程兰花. 昌吉市医疗卫生资源优化配置研究[D]. 新疆乌鲁木齐. 中国科学院大学,2018. |
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