本文選題：衛(wèi)生資源　切入點：公平性　出處：《寧夏醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：背景:2009年新醫(yī)改以來,我國政府對衛(wèi)生事業(yè)的關(guān)注度不斷提高,建立起了較為健全的基本醫(yī)療保障體系,國家投入大量資金發(fā)展醫(yī)療衛(wèi)生事業(yè)。然而,時至今日群眾“看病難、看病貴”的問題并未得到明顯改善,廣大人民群眾日益增長的醫(yī)療衛(wèi)生需求同有限的醫(yī)療衛(wèi)生資源之間的矛盾依然突出,衛(wèi)生資源配置的公平性和合理性是我國衛(wèi)生事業(yè)發(fā)展和改革必須解決的重點問題和亟待研究的重要課題。目的:本文收集全國和寧夏衛(wèi)生統(tǒng)計年鑒、衛(wèi)生事業(yè)發(fā)展公報等資料中寧夏衛(wèi)生資源配置量情況,結(jié)合社會經(jīng)濟與衛(wèi)生事業(yè)發(fā)展狀況,運用經(jīng)濟學評價方法深入分析寧夏衛(wèi)生人力、物力和財力資源配置的現(xiàn)狀和公平程度,試圖通過寧夏衛(wèi)生資源配置中存在的主要問題,為新醫(yī)改提出一些合理化建議,供政府決策部門參考。方法:本文采用描述性分析法對寧夏衛(wèi)生資源配置現(xiàn)狀進行分析,運用Lorenz曲線、基尼系數(shù)和泰爾指數(shù),對2009-2015年寧夏衛(wèi)生人力、物力和財力三大資源的人口和地理配置的公平性進行分析,利用層次分析法確定各衛(wèi)生資源指標對總指標體系的權(quán)重,并結(jié)合Topsis法對5個地市的衛(wèi)生資源配置進行綜合評價.結(jié)果:1.衛(wèi)生人力資源方面:6年間,衛(wèi)生人員總量持續(xù)穩(wěn)增,衛(wèi)生人員增加了15813人,衛(wèi)生人員增量主要集中在衛(wèi)技人員。衛(wèi)生人力資源人口配置基尼系數(shù)均在0.40以下,且呈下降趨勢,人口配置公平性較好;地理配置基尼系數(shù)均在0.40以上,且呈上升趨勢,地理配置公平性差;尤其是注冊護士和管理人員配置公平性較差。衛(wèi)生人力資源地市內(nèi)差異的對總差異的貢獻率均在51.00%以上,高于地市間差異的貢獻率。2.衛(wèi)生物力資源方面:各類衛(wèi)生機構(gòu)和床位總量均呈上升趨勢,截止2015年,全區(qū)共有各類醫(yī)療機構(gòu)4289家,床位數(shù)33804張。醫(yī)療機構(gòu)和床位人口配置基尼系數(shù)均低于0.20,地理配置公平性均低于0.40,衛(wèi)生物力資源人口配置公平性優(yōu)于地理配置。寧夏物力資源的區(qū)內(nèi)差異對總體差異的貢獻率均在62.00%以上,明顯大于區(qū)間差異對總體差異的貢獻率。3.衛(wèi)生財力資源:2009-2015年,寧夏衛(wèi)生總費用占GDP比重從6.32%增加至7.89%,逐年穩(wěn)步增加;政府衛(wèi)生預算支出增長速度高于GDP增長速度,均明顯高于全國平均水平。衛(wèi)生財政補助人口配置基尼系數(shù)均低于0.20,人口配置絕對公平;地理配置基尼系數(shù)均低于0.40,人口配置公平性優(yōu)于地理配置。4.綜合評價:2015年寧夏5個地市衛(wèi)生資源配置于最優(yōu)方案的接近程度在0.1582-0.6904之間,各地市之間的資源配置差異較大;經(jīng)Topsis法排序,衛(wèi)生資源配置最“差”的是中衛(wèi)市,C值為0.1582;最“好”的是銀川市,C值為0.6904。6年來,除銀川市和石嘴山市外,吳忠市、固原市和中衛(wèi)市衛(wèi)生資源配置的C值均有所上升。結(jié)論:2009-2015年,寧夏衛(wèi)生資源總量逐年遞增,且人均衛(wèi)生資源擁有量總體上高于國家平均水平,但存在地區(qū)差異,注冊護士和管理人員總量相對較少�；诨嵯禂�(shù)分析的寧夏衛(wèi)生人力、物力和財力資源配置總體處于公平狀態(tài)且逐漸提高,三種衛(wèi)生資源按人口配置公平性均優(yōu)于按地理配置�；谔栔笖�(shù)分析的寧夏衛(wèi)生人力、物力和財力資源配置總體處于公平狀態(tài),且三種資源配置的公平性均受區(qū)域內(nèi)資源配置的影響較大�；趯哟畏治龇ǖ男l(wèi)生資源權(quán)重排序從高到低依次為衛(wèi)生人力、財力和物力資源�；赥opsis法的寧夏衛(wèi)生資源配置綜合排序從高到低依次為銀川市、石嘴山市、固原市、吳忠市和中衛(wèi)市。建議:1.科學制定區(qū)域衛(wèi)生規(guī)劃,促進衛(wèi)生資源的優(yōu)化整合。2.加大財政投入,完善基層醫(yī)療衛(wèi)生服務(wù)體系建設(shè)。3.多措并舉,建立衛(wèi)生人力資源發(fā)展長效機制。4.以實際需要為導向,改善衛(wèi)生資源配置公平性。5.以病人實際需求為導向,合理配置衛(wèi)生人才資源。6.以艱邊地區(qū)為重點,推進全區(qū)衛(wèi)生事業(yè)協(xié)同發(fā)展
[Abstract]:Background: in 2009 since the new medical reform, the Chinese government in the health sector increasing attention to establish a basic medical insurance system more perfect, the state invested heavily in the development of medical and health services. However, today the "difficult and expensive" problem has not been significantly improved, the contradiction between the masses is the growth of medical and health needs with limited health resources is still outstanding, health resource allocation fairness and rationality is an important subject of key issues and reform of the health development of our country must solve urgently and research. Objective: this collection of national and Ningxia Health Statistics Yearbook, Ningxia health resources allocation health development bulletin the data in the situation, combined with the status of social economic development and health, using the economic evaluation method in-depth analysis of Ningxia health manpower, material resources and The status quo and fairness of the allocation of financial resources, attempts through the main problems existing in Ningxia in the allocation of health resources, and puts forward some reasonable suggestions for the new health care reform, for government decision-making departments for reference. Methods: This paper adopts descriptive analysis method to analyze the current situation of the health resources in Ningxia, using the Lorenz curve, Gini coefficient and Theil index of 2009-2015 years of health manpower in Ningxia, analyze the fairness of population and geographic configuration of the three material and financial resources, using the AHP to determine the weight of each index of total health resources index system, combined with Topsis method, comprehensive evaluation of health resource allocation in 5 cities. Results: 1. health human resources 6 years, the total health personnel and health personnel continued steady growth, an increase of 15813, mainly concentrated in the incremental health personnel of health technical personnel. Health human resource allocation Gini coefficient of population The number is below 0.40, and the downward trend of the equitable allocation of population geographic configuration is better; the Gini coefficient was above 0.40, and the upward trend, the geographical configuration fairness; especially the registered nurse staffing and management of poor fairness. The city differences in health human resources of the total difference contribution rate more than 51%, higher than the difference between the contribution rate of.2. health material resources: the total amount of various health institutions and beds showed an upward trend, as of 2015, there were altogether 4289 types of medical institutions, 33804 beds. The beds of medical institutions and the population allocation Gini coefficient was lower than 0.20, fairness was lower than that of geography 0.40, physical health fair population resources allocation is better than the geographic allocation. Ningxia resources in the region difference of the difference of the overall contribution rate was more than 62%, significantly higher than the interval difference to overall difference contribution Contribution rate of.3. health financial resources: 2009-2015 years, Ningxia total health expenditure accounted for the proportion of GDP increased from 6.32% to 7.89%, the growth rate increased steadily year by year; the health budget government spending is higher than the GDP growth rate, were significantly higher than the national average. Health subsidies population distribution Gini coefficient was lower than 0.20, the absolute population allocation fairness; geographic configuration Gini the coefficient is less than 0.40, fair allocation is better than that of the population geographic configuration.4. comprehensive evaluation: 2015 5 cities of Ningxia health resource allocation scheme in proximity to the optimal allocation of resources between 0.1582-0.6904, the difference between the larger around the city; by the method of Topsis scheduling, allocation of health resources in the "poor" is a central defender, C value 0.1582; the "good" is the city of Yinchuan, the C value is 0.6904.6 years, in addition to Yinchuan city and Shizuishan City, Wuzhong City, distribution of health resources in Guyuan city and the city centre are on the C value L. Conclusion: 2009-2015 years, the amount of health resources in Ningxia is increasing year by year, and the per capita health resources generally higher than the national average level, but the regional difference, the total amount of registered nurses and managers is relatively small. The Gini coefficient of Ningxia based on the analysis of health manpower, material and financial resources in the overall state fair and gradually increased. Three according to the equitable allocation of health resources are better than the population according to the geographical configuration. The Theil index analysis of Ningxia health based on human, material and financial resources allocation in the overall state fair, and three kinds of fair resource allocation are affected by the allocation of resources within the region greatly. Health resources AHP based sorting from high to low for health manpower, financial and material resources. Based on the Topsis method of Ningxia health resource allocation ranking from high to low are Yinchuan City, Shizuishan city, Guyuan City, Wuzhong City and city centre. 1. suggestions: establishing regional health planning, optimization and integration of.2. to promote health resources to increase financial investment, improve the construction of basic medical and health service system.3. Duocuobingju, establish health human resources development mechanism.4. to actual needs as the guidance, improve the equity of health resources allocation to.5. patient demand oriented, rational allocation of health human resources in.6. difficult boundary areas, promote the region's health coordinated development

【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R197.1

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