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中国医院传染病医疗救治卫生资源及服务水平时空公平性分析:基于莫兰指数和基尼系数

Spatial and temporal equity of health resources and service levels for medical treatment of infectious diseases in hospitals in China: based on Moran′s index and Gini coefficient

  • 摘要:
    目的 分析2018—2022年全国各地区医院传染科卫生资源与服务水平变化趋势,为优化资源配置,提高医疗机构传染病防治能力提供证据支持。
    方法 以《中国统计年鉴(2023)》和《中国卫生健康统计年鉴(2019—2023)》中全国和各省统计数据为基础,在分析法定传染病发病情况、传染病科医疗卫生资源分布和医疗服务提供情况基础上,基于洛伦兹曲线、基尼系数、卫生资源密度指数和莫兰指数评价2018—2022年我国传染病救治卫生资源及服务供给时空公平性。
    结果 2018—2022年,全国医院传染科床位数增长3万张,执业(助理)医师数增长1万人,复合增长率分别为5.25%、15.91%,相较于医院总体水平增速明显,但在医院总体中占比仍较低。2022年,我国医院传染科床位数、门急诊人次数、出院人次数3项指标按人口配置的基尼系数为0.153、0.200、0.183,按地理面积配置的基尼系数为0.612、0.717、0.639,人口公平性优于地理公平性。2018—2022年,3项指标卫生资源密度指数的Moran′s I在0.236~0.475之间,呈现正空间自相关,存在空间聚集性。低–低聚集区主要分布于西北、西南地区,高–高聚集区主要为华东地区,低–高聚集区主要包括河北省、安徽省、湖北省、江西省等地,分布于高–高聚集区附近。
    结论 我国医院传染科存在卫生资源总量占比较低、各地区资源及服务量差距较大、发展滞缓地区集聚分布的问题,应从加强政策支持及财政投入、促进医疗资源协调布局、提高社会防治意识3个方面提升医疗机构传染病防治能力。

     

    Abstract:
    Objective To analyze the variation trends of health resources and service levels of infectious disease departments in hospitals in different regions of China from 2018 to 2022, thus providing evidence for optimizing resource allocation and improving the ability of medical institutions to prevent and control infectious diseases.
    Methods The national and provincial statistical data from China Statistical Yearbook (2023) and China Health Statistics Yearbook (2019 to 2023) were used to analyze the incidence of notifiable infectious diseases, the distribution of medical resources, and the provision of medical services in infectious diseases departments. The Lorentz curve, Gini coefficient, health resource density index, and Moran′s index were adopted to evaluate the spatial and temporal equity of health resources and service supply for infectious disease treatment in China from 2018 to 2022.
    Results From 2018 to 2022, the number of beds in infectious disease departments of hospitals in China increased by 30 000 and the number of practicing (assistant) physicians increased by 10 000, with compound growth rates of 5.25% and 15.91%, respectively, which were significantly higher than the overall growth rates of hospitals but still accounted for a low proportion in the overall hospitals. In 2022, the Gini coefficients of the number of beds in infectious disease department, the number of outpatients and emergency patients, and the number of discharged patients according to the population allocation were 0.153, 0.200, and 0.183, respectively, and those according to geographical allocation were 0.612, 0.717, and 0.639, respectively, indicating that population equity was better than geographical equity. From 2018 to 2022, the Moran′s index of the health resource density index of the three indicators ranged from 0.236 to 0.475, showing positive spatial autocorrelation and spatial clustering. The low-low clustering areas were mainly distributed in northwestern and southwestern China, the high-high clustering areas in eastern China, and the low-high clustering areas in Hebei, Anhui, Hubei, Jiangxi and other places near the high-high clustering areas.
    Conclusion The infectious disease departments of hospitals in China faced problems such as a low proportion of health resources, large disparity of resources and services among different regions, and agglomeration of areas with slow development. The capacity of medical institutions to prevent and control infectious diseases should be enhanced from three aspects: strengthening policy support and financial input, promoting the coordinated allocation of medical resources, and raising social awareness of prevention and control.

     

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