中国内地2004 — 2020年医防融合协调水平发展情况分析

闫温馨; 郭欣; 刘霞; 梁万年; 刘珏

doi:10.11847/zgggws1140422

中国内地2004 — 2020年医防融合协调水平发展情况分析

Trend in coordination for integration of medical treatment and disease prevention in the mainland of China, 2004 – 2020: a statistical data based analysis

摘要

摘要:
目的了解中国2004 — 2020年内地31个省（自治区、直辖市）的医防融合协调水平发展情况，为促进新时期健康中国建设的医防融合提供参考建议。
方法通过收集2004 — 2020年《中国卫生健康统计年鉴》和《中国统计年鉴》相关资料，整理衡量医疗系统和公卫系统综合发展水平的相关指标，构建耦合协调模型和中断时间序列模型，检验“新医改”政策对医防融合子系统发展水平及耦合协调程度的瞬时影响和持续影响情况。
结果 2004 — 2020年中国内地医疗系统综合发展水平（S_Y）从2004年的0.560提高至2020年的0.692，各省（自治区、直辖市）S_Y从2004年的0.385～0.655提高至2020年的0.524～0.758；中国公卫系统综合发展水平（S_G）从2004年的0.747提高至2020年的0.875，各省（自治区、直辖市）S_G从2004年的0.501～0.846提高至2020年的0.696～0.995。2004 — 2020年中国内地和各省（自治区、直辖市）医防系统耦合度（C）均 > 0.9，处于高水平耦合阶段；全国医防融合耦合协调度（D）从2004年的0.805提高至2020年的0.880，各省（自治区、直辖市）D从2004年的0.663～0.852提高至2020年的0.777～0.930。2020年，东部地区S_Y为0.573～0.703，S_G为0.764～0.901，东部地区S_Y和S_G均最高。中断时间序列模型分析结果显示，“新医改”政策实行后对多个省（自治区、直辖市）S_Y产生了显著的瞬时影响（β₂ = 0.024～0.145，均P < 0.05）和持续影响（β₃ = 0.004～0.032，均P < 0.05），但对S_G的影响不大。
结论中国内地2004 — 2020年医防融合子系统综合发展水平不断提高，医防融合耦合协调程度逐渐加强，但仍存在地区差异。

Abstract:
Objective To examine the development of coordination for the integration of medical treatment and disease prevention (treatment-prevention) in 31 provincial level administrative divisions (PLADs) across China during 2004 – 2020 and to provide a reference for promoting the integration of treatment and prevention in Healthy China construction.
Methods Base on the data collected from the China Health Statistical Yearbook and the China Statistical Yearbook of 2004 – 2020, we compiled relevant indicators for measuring comprehensive development of the medical system and the public health system at national level and PLAD level. We conducted a coupling coordination model analysis and an interrupted time series model analysis (ITSA) to test instantaneous and persistent impact of the “New Medical System Reform Policy” on the development, the degree of coupling, and coordination of the treatment-prevention integration subsystem.
Results From 2004 to 2020, the index for comprehensive development of medical system (S_Y) increased from 0.560 to 0.692 at national level and the S_Yalso increased for all the PLADs with the ranges from 0.385 – 0.655 to 0.524 – 0.758; during the same period, the index for comprehensive development public health system (S_G) increased from 0.747 to 0.875 at national level and the S_G of all the PLADs increased similarly in the ranges from 0.501 – 0.846 to 0.696 – 0.995. The range-specific S_Y and S_G were the highest for the PLADs in eastern China in 2020, with the ranges of 0.573 – 0.703 for S_Y and 0.764 – 0.901 for S_G. The results of ITSA showed that the “New Medical System Reform Policy” had a significant transient impact (β₂ = 0.024 – 0.145, P < 0.05) and persistent impact (β₃ = 0.004 – 0.032, P < 0.05) on the development of medical system (S_Y) in most PLADs, but not on public health system (S_G). From 2004 to 2020, the coupling degree (C) of medical system and public health system at national and PLADs level were all above 0.9, indicating a good system coupling. The index (D) for degree of coordination in treatment-prevention integration increased from 0.805 in 2004 to 0.880 in 2020 at national level and the range of D increased from 0.663 – 0.852 in 2004 to 0.777 – 0.930 in 2020 at PLAD level.
Conclusion Comprehensive development of treatment-prevention integration subsystem in has been improving during 2004 – 2020 in China, and the degree of coupling coordination in treatment-prevention integration has been gradually strengthened, but regional difference still exists.

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