背景:随着居民收入的逐步提高和医疗保障制度的不断完善,人们追求更高质量、更好的医疗卫生服务的需求得到释放。然而,到目前为止,关于中国优质医疗资源(HQMR)的研究很少。本研究旨在了解2006-2020年HQMR的时空变化趋势,分析2020年HQMR的区域差异,进一步探讨影响中国HQMR分布的主要因素。
方法:本研究选取三级甲等医院(中国最高级别的医疗机构)代表HQMR。描述性统计方法用于解决2006年至2020年HQMR分布的变化。洛伦兹曲线,基尼系数(G),采用泰尔指数(T)和优质卫生资源密度指数(HHRDI)计算不公平程度。利用地理探测器方法揭示了影响HQMR分布的关键因素。
结果:中国的HQMR总量逐年增加,从2006年的647家三级甲等医院到2020年的1580家。2020年,按人口计算的HQMRG为0.166,按地理区域计算为0.614。T与G的结果一致,区域内缴款率高于区域间缴款率。HHRDI显示,北京,上海,天津的HQMR分配金额最高。地理探测器的结果显示,总卫生费用,政府卫生支出,常住人口的规模,GDP,医学院校数量对HQMR的空间分布有显著影响,q值分别为0.813、0.781、0.719、0.661、0.492。影响因素之间存在交互作用。
结论:中国的总HQMR增长迅速,但相对不足。HQMR按人口分布优于按地理分布,按地理位置划分的分配不太公平。在制定政策时,需要考虑人口规模和地理区域,而不是简单地增加HQMR的数量。
With the gradual increase of residents\' income and the continuous improvement of medical security system, people\'s demand for pursuing higher quality and better medical and health services has been released. However, so far little research has been published on
China\'s high quality medical resources (HQMR). This study aims to understand the spatiotemporal variation trend of HQMR from 2006 to 2020, analyze regional disparity of HQMR in 2020, and further explore the main factors influencing the distribution of HQMR in China.
The study selected Class III level A hospitals (the highest level medical institutions in
China) to represent HQMR. Descriptive statistical methods were used to address the changes in the distribution of HQMR from 2006 to 2020. Lorentz curve, Gini coefficient (G), Theil index (T) and High-quality health resource density index (HHRDI) were used to calculate the degree of
inequity. The geographical detector method was used to reveal the key factors influencing the distribution of HQMR.
The total amount of HQMR in
China had increased year by year, from 647 Class III level A hospitals in 2006 to 1580 in 2020. In 2020, G for HQMR by population was 0.166, while by geographic area was 0.614. T was consistent with the results for G, and intra-regional contribution rates were higher than inter-regional contribution rates. HHRDI showed that Beijing, Shanghai, and Tianjin had the highest allocated amounts of HQMR. The results of the geographical detector showed that total health costs, government health expenditure, size of resident populations, GDP, number of medical colleges had a significant impact on the spatial distribution of HQMR and the q values were 0.813, 0.781, 0.719, 0.661, 0.492 respectively. There was an interaction between the influencing factors.
China\'s total HQMR is growing rapidly but is relatively inadequate. The distribution of HQMR by population is better than by geography, and the distribution by geography is less equitable. Population size and geographical area both need to be taken into account when formulating policies, rather than simply increasing the number of HQMR.