新医改前后我国医院卫生服务利用公平性分析
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摘要
目的:描述并对比新医改前后我国医院卫生服务利用公平性及其变化趋势。方法:用省级数据分析医院就诊人次和医院入院人数的公平性,并利用需要因素进行校正,分别采用集中指数和回归模型分析和比较新医改前后卫生服务利用的公平性及东中西部地区间差异的变化。结果:我国医院卫生服务利用数量逐年增加;公平性逐渐好转,平均就诊次数的公平性比年住院率差,据需要校正后的卫生服务利用公平性相对较差;新医改前后平均就诊次数的东西部地区差异拉大,年住院率的差异减小。结论:根据居民健康需要进行卫生资源的配置,有效提高卫生服务的可及性;重点关注医院平均就诊次数的公平性;关注资源投入转化为卫生服务利用的程度。
Objective: To describe and compare the equity and change trend of health utilization in hospital before and after new medical reform. Methods: Province-level data were used to analyze the equity of outpatient visits and hospital admissions in hospital.Variables were standardized by demand factors. Concentration index and regression model were respectively used to compare and analyze the equity of health service utilization and the changes of disparities among different regions in hospital before and after the new medical reform. Results: The quantity of health utilization in China's hospitals was increased by years. The equity was getting better. The equity of average number of outpatient visits was worse than hospital admission rate. The equity of adjusted health utilization in hospital was worse after the adjustment. The differences of the average visit number between eastern and western regions was enlarging before and after the new medical reform. The difference of annual hospitalization rate was decreased. Conclusion:Health resource allocation should be based on resident health demand, which could effectively improve health service access. The equity of average number of outpatient visits should be focused on. It needed to focus on how much health resource input could be used by patients.
Objective: To describe and compare the equity and change trend of health utilization in hospital before and after new medical reform. Methods: Province-level data were used to analyze the equity of outpatient visits and hospital admissions in hospital.Variables were standardized by demand factors. Concentration index and regression model were respectively used to compare and analyze the equity of health service utilization and the changes of disparities among different regions in hospital before and after the new medical reform. Results: The quantity of health utilization in China's hospitals was increased by years. The equity was getting better. The equity of average number of outpatient visits was worse than hospital admission rate. The equity of adjusted health utilization in hospital was worse after the adjustment. The differences of the average visit number between eastern and western regions was enlarging before and after the new medical reform. The difference of annual hospitalization rate was decreased. Conclusion:Health resource allocation should be based on resident health demand, which could effectively improve health service access. The equity of average number of outpatient visits should be focused on. It needed to focus on how much health resource input could be used by patients.
引文
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[19]国务院办公厅.国务院办公厅关于印发全国医疗卫生服务体系规划纲要(2015-2020年)的通知.[EB/OL].(2018-3-5)[2019-01-07].http://www.gov.cn/zhengce/content/2015-03/30/content_9560.htm.
[20]刘相瑜,于贞杰,李向云,等.卫生服务公平性研究进展综述[J].中国卫生事业管理,2011(5):323-325.
[21]姚中宝,张帆,孙玉凤,等.某省居民卫生服务利用的公平性分析[J].中国卫生事业管理,2016,33(7):517-519.
[22]王爱芹,孟明珠,孔丽娜,等.我国卫生服务利用省际公平性研究[J].中国卫生统计,2015,32(5):815-817.
[23]姚瑶,刘国恩.健康与卫生服务利用的不平等:来自省级数据的证据[J].中国卫生经济,2018,37(2):62-65.
[24]ANSELMI L,LAGARDE M,HANSON K.Health service availability and health seeking behaviour in resource poor settings:evidence from Mozambique[J].Health economics review,2015,5(1):1-13.
[25]国务院办公厅.国务院关于印发“十三五”卫生与健康规划的通知.[EB/OL].(2018-10-31)[2019-01-07].http://www.gov.cn/zhengce/content/2017-01/10/content_5158488.htm.
[2]毛璐,秦江梅,芮东升,等.东中西部城市卫生服务利用公平性比较:基于社区卫生综合改革典型城市居民健康询问调查[J].中国卫生经济,2013(11):54-56.
[3]谢小平,刘国祥,李斌,等.卫生服务利用公平性方法学研究[J].中国卫生经济,2007,26(5):74-76.
[4]国务院办公厅.中共中央国务院关于深化医药卫生体制改革的意见.[EB/OL].(2018-3-5)[2019-01-07].http://www.gov.cn/test/2009-04/08/content_1280069.htm.
[5]国家卫生计生委.2016年我国卫生和计划生育事业发展统计公报.[EB/OL].(2018-3-5)[2019-01-07].http://www.nhfpc gov.cn/guihuaxxs/s10748/201708/d82fa7141696407abb4ef764f3edf095.shtml.
[6]国家统计局.中国统计年鉴[M].北京:中国统计出版社,2006-2017.
[7]国家卫生部.中国卫生统计年鉴[M].北京:中国协和医科大学出版社,2006-2012.
[8]国家卫生和计划生育委员会.中国卫生和计划生育统计年鉴[M].北京:中国协和医科大学出版社,2013-2017.
[9]O’DONNELL O,DOORSLAER E V,WAGSTAFF A,et al Analyzing health equity using household survey data[R].Washington DC.:The World Bank,2008.
[10]JENKINS S.Calculating income distribution indices from Microdata[J].National eax journal,1988(61):139-142.
[11]KAKWANI N C.Income inequality and poverty:methods of estimation and policy applications[M].New York:Oxford University Press,1980.
[12]LERMAN R I,YITZHAKI S.Improving the accuracy of estimates of Gini coefficients[J].Journal of econometrics,1989,42(1):43-47.
[13]World Health Organization.Handbook on health inequality monitoring:with a special focus on low-and middle-income countries[R].Geneva:World Health Organization,2013.
[14]JACKSON J W,WILLIAMS D R,VANDERWEELE T J.Disparities at the intersection of marginalized groups[J].Social psychiatry and psychiatric epidemiology,2016,51(10):1349-1359.
[15]国务院办公厅.国务院批转卫生事业发展“十一五”规划纲要的通知.[EB/OL].(2018-3-5)[2019-01-07].http://www.gov.cn/zhengce/content/2008-03/28/content_6193.htm.
[16]国务院办公厅.国务院关于印发卫生事业发展“十二五”规划的通知.[EB/OL].(2018-3-5)[2019-01-07].http://www gov.cn/zhengce/content/2012-10/19/content_6074.htm.
[17]国务院办公厅.国务院关于印发“十二五”期间深化医药卫生体制改革规划暨实施方案的通知.[EB/OL].(2018-3-5)[2019-01-07].http://www.gov.cn/zhengce/content/2012-03/21/content_6094.htm.
[18]胡宏伟.城镇居民医疗保险对卫生服务利用的影响--政策效应与稳健性检验[J].中南财经政法大学学报,2012(5)21-28.
[19]国务院办公厅.国务院办公厅关于印发全国医疗卫生服务体系规划纲要(2015-2020年)的通知.[EB/OL].(2018-3-5)[2019-01-07].http://www.gov.cn/zhengce/content/2015-03/30/content_9560.htm.
[20]刘相瑜,于贞杰,李向云,等.卫生服务公平性研究进展综述[J].中国卫生事业管理,2011(5):323-325.
[21]姚中宝,张帆,孙玉凤,等.某省居民卫生服务利用的公平性分析[J].中国卫生事业管理,2016,33(7):517-519.
[22]王爱芹,孟明珠,孔丽娜,等.我国卫生服务利用省际公平性研究[J].中国卫生统计,2015,32(5):815-817.
[23]姚瑶,刘国恩.健康与卫生服务利用的不平等:来自省级数据的证据[J].中国卫生经济,2018,37(2):62-65.
[24]ANSELMI L,LAGARDE M,HANSON K.Health service availability and health seeking behaviour in resource poor settings:evidence from Mozambique[J].Health economics review,2015,5(1):1-13.
[25]国务院办公厅.国务院关于印发“十三五”卫生与健康规划的通知.[EB/OL].(2018-10-31)[2019-01-07].http://www.gov.cn/zhengce/content/2017-01/10/content_5158488.htm.