發(fā)布時(shí)間：2018-05-06 04:08

  本文選題：衛(wèi)生機(jī)構(gòu) + 資源配置�。� 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本文通過對(duì)河北省醫(yī)療衛(wèi)生服務(wù)機(jī)構(gòu)資源配置現(xiàn)狀進(jìn)行描述和統(tǒng)計(jì)分析,探索本省居民醫(yī)療衛(wèi)生服務(wù)需求的發(fā)生發(fā)展規(guī)律,發(fā)現(xiàn)我省醫(yī)療衛(wèi)生服務(wù)機(jī)構(gòu)資源配置存在的問題并找出原因,根據(jù)未來五年的社會(huì)經(jīng)濟(jì)發(fā)展和醫(yī)療衛(wèi)生服務(wù)需求,提出河北省“十三五”醫(yī)療衛(wèi)生服務(wù)機(jī)構(gòu)規(guī)劃建議,為政府制定“十三五”規(guī)劃提供參考。方法:1文獻(xiàn)研究。利用中國(guó)學(xué)術(shù)期刊網(wǎng)(CNKI)、萬(wàn)方數(shù)據(jù)庫(kù)、維普數(shù)據(jù)等途徑收集國(guó)內(nèi)外有關(guān)的區(qū)域衛(wèi)生規(guī)劃制定方法和有效性評(píng)價(jià)的文獻(xiàn),歸納總結(jié),形成綜述,作為本課題的研究思路。全面解析我國(guó)的醫(yī)療改革方針政策,對(duì)規(guī)劃的背景有所了解,參考全國(guó)“十三五”規(guī)劃編制原則和要求,在對(duì)資源配置進(jìn)行全面了解的同時(shí)為我省“十三五”規(guī)劃提出政策建議。2數(shù)據(jù)整理分析。采用描述性統(tǒng)計(jì)的方法,分析研究河北省各市的醫(yī)療衛(wèi)生服務(wù)機(jī)構(gòu)資源配置現(xiàn)狀,其中包括醫(yī)療衛(wèi)生機(jī)構(gòu)配置現(xiàn)狀、衛(wèi)生人力資源配置現(xiàn)狀、床位配置現(xiàn)狀、醫(yī)療機(jī)構(gòu)設(shè)備配置現(xiàn)狀、衛(wèi)生經(jīng)費(fèi)、居民健康狀況等,對(duì)搜集的數(shù)據(jù)進(jìn)行整理分析,現(xiàn)有資料進(jìn)行現(xiàn)狀描述,發(fā)現(xiàn)問題,提出政策建議。3專家咨詢。為制定最佳的研究設(shè)計(jì)方案,探索河北省醫(yī)療衛(wèi)生服務(wù)機(jī)構(gòu)資源配置現(xiàn)狀存在的主要問題,得出較為有意義的統(tǒng)計(jì)結(jié)果,邀請(qǐng)河北省內(nèi)醫(yī)院管理、社會(huì)醫(yī)學(xué)與衛(wèi)生事業(yè)管理、衛(wèi)生經(jīng)濟(jì)領(lǐng)域等的專家,進(jìn)行分組討論研究。4公平性統(tǒng)計(jì)分析。洛倫茲(Lorenz)曲線的縱軸為不同地區(qū)擁有衛(wèi)生資源數(shù)量構(gòu)成的百分比,并按其大小進(jìn)行排序,其橫軸為對(duì)應(yīng)地區(qū)的人口累計(jì)百分比,將每個(gè)點(diǎn)連接,繪制成洛倫茲曲線。45度對(duì)角線作為參考線,也叫做公平線。如果衛(wèi)生資源配置比較接近于公平,曲線就越靠近公平線(45度對(duì)角線);反之,就遠(yuǎn)離公平線。以絕對(duì)公平線與洛倫茲曲線圍成的面積為分子,絕對(duì)公平線下直角三角形面積為分母,其比值稱作基尼系數(shù)�；嵯禂�(shù)取值介于0到1之間,各個(gè)地區(qū)資源分布越公平,基尼系數(shù)越接近0;反之,基尼系數(shù)越接近1。各個(gè)地區(qū)資源絕對(duì)平均,基尼系數(shù)小于0.2;資源分布比較平均,基尼系數(shù)大于0.2小于0.3;資源分布基本合理,基尼系數(shù)大于0.3小于0.4;資源分布差距較大,基尼系數(shù)大于0.4小于0.5;資源分布差距懸殊,基尼系數(shù)為0.5;資源分布處于高度不公平的危險(xiǎn)狀態(tài),基尼系數(shù)則大于0.6。國(guó)際上將0.4作為“警戒線”。所有數(shù)據(jù)均采用spss13.0和excel2007進(jìn)行統(tǒng)計(jì)分析。結(jié)果:1河北省由11個(gè)地級(jí)市構(gòu)成,總面積約18.88萬(wàn)平方公里,有7383.75萬(wàn)常住人口,城市人口占49.33%,農(nóng)村人口占50.67%,男女比例1.03:1,常住人口中有677.09萬(wàn)人為65歲以上老年人口,占總?cè)丝诘?.17%;有1314.30萬(wàn)人為14歲以下兒童,占17.80%;22014年河北省生產(chǎn)總值達(dá)到29421.15億元,2013年為28442.95億元。2014年人均gdp為39984元;城市居民人均可支配收入24141.34,農(nóng)村居民為10186.14,城鎮(zhèn)居民家庭恩格爾系數(shù)為26.17%,農(nóng)村居民家庭達(dá)29.36%;3我省共有78906個(gè)醫(yī)療衛(wèi)生機(jī)構(gòu),其中醫(yī)院1341個(gè),綜合醫(yī)院894個(gè),基層醫(yī)療衛(wèi)生機(jī)構(gòu)75624個(gè),其中包括衛(wèi)生院1960,社區(qū)衛(wèi)生服務(wù)中心1169,專業(yè)公共衛(wèi)生機(jī)構(gòu)1667。我省綜合醫(yī)院數(shù)量最多達(dá)894個(gè),中醫(yī)院、專科醫(yī)院數(shù)量較少。從醫(yī)療機(jī)構(gòu)的比例可以看出,基層醫(yī)療機(jī)構(gòu)的比例最大,占醫(yī)療機(jī)構(gòu)總量的94.6%,其次是公共衛(wèi)生機(jī)構(gòu),中醫(yī)院所占比例最小,僅占0.2%;4河北省所有醫(yī)療衛(wèi)生服務(wù)機(jī)構(gòu)共有床位數(shù)322909張,其中醫(yī)院有236889張,基層醫(yī)療衛(wèi)生機(jī)構(gòu)73108張,專業(yè)公共衛(wèi)生機(jī)構(gòu)11907張,各地區(qū)床位數(shù)分布如table5,床位數(shù)最多集中在石家莊,邯鄲、保定,秦皇島衡水醫(yī)療機(jī)構(gòu)床位數(shù)分布較少。河北省共有醫(yī)師數(shù)157725人,石家莊擁有的醫(yī)師數(shù)最多,達(dá)到49496人,張家口醫(yī)師數(shù)最少僅7352人,千人口執(zhí)業(yè)醫(yī)師數(shù)石家莊秦皇島較高,具體詳見table6,石家莊的護(hù)士數(shù)最多,達(dá)22773人;5河北省醫(yī)療衛(wèi)生資源配置數(shù)量,如床位數(shù)、執(zhí)業(yè)醫(yī)師數(shù)和注冊(cè)護(hù)士數(shù)與人口數(shù)顯著相關(guān),可以根據(jù)擬合出的公式,預(yù)測(cè)未來五年人口數(shù)變化從而預(yù)測(cè)相應(yīng)的床位數(shù)、執(zhí)業(yè)醫(yī)師數(shù)、注冊(cè)護(hù)士數(shù)的配置數(shù)量;6河北省十一個(gè)市醫(yī)療衛(wèi)生機(jī)構(gòu)床位數(shù)、執(zhí)業(yè)醫(yī)師數(shù)和護(hù)士數(shù)配置公平性按照常駐人口進(jìn)行配置時(shí)基尼系數(shù)分別為0.1462、0.1132、0.1346,均小于0.2,公平性較好。結(jié)論:僅從人口需求和地域分布來看,河北省的醫(yī)療衛(wèi)生服務(wù)資源能夠適應(yīng)居民醫(yī)療健康的基本需求,醫(yī)療衛(wèi)生資源分布比較均衡,公平性較好。醫(yī)療衛(wèi)生資源的數(shù)量與人口數(shù)有一定的線性關(guān)系,受人口策略因素影響較大,未來在優(yōu)化衛(wèi)生資源配置時(shí)考慮人口數(shù)量變化以及人口策略影響,醫(yī)療衛(wèi)生服務(wù)機(jī)構(gòu)設(shè)置應(yīng)該隨著計(jì)劃生育政策的變化和人口老齡化發(fā)展作適度調(diào)整和增量,還應(yīng)考慮社會(huì)經(jīng)濟(jì)、財(cái)政投入、醫(yī)療衛(wèi)生政策變革等因素,以確保規(guī)劃實(shí)施。
[Abstract]:Objective: through the description and statistical analysis of the resources allocation status of medical and health service institutions in Hebei Province, this paper explores the law of the development of the medical and health service requirements of the residents in this province, and finds out the existing problems in the allocation of medical and health service institutions in our province and finds out the reasons, according to the social and economic development and medical health in the next five years. In order to provide a proposal for the planning of the "13th Five-Year" medical and health service organization in Hebei Province, this paper provides a reference for the government to formulate the "13th Five-Year" plan. Method: 1 literature research. Using the Chinese Academic Journal Network (CNKI), the Wanfang database, and VP data to collect the articles on the formulation and effectiveness evaluation of regional health planning at home and abroad. A comprehensive analysis of China's medical reform policy, understanding of the planning background, the national "13th Five-Year" planning principles and requirements, a comprehensive understanding of the allocation of resources, and a policy suggestion for the "13th Five-Year" plan of the province, as well as the policy recommendations for the "13th Five-Year".2. A descriptive statistics method was used to analyze the status of the resources allocation of medical and health service institutions in Hebei Province, including the status of medical and health institutions, the status of health human resources allocation, the status of bed configuration, the status of medical facilities, health funds, health status of residents and so on. In order to make the best research design scheme and explore the main problems existing in the status quo of the resources allocation in Hebei medical and health service institutions, we can draw up more meaningful statistical results and invite the hospital management in Hebei Province, social medicine and health affairs in Hebei province. The experts in the industry management, the health economy field, etc., carry out group discussion and study the.4 fairness statistical analysis. The longitudinal axis of the Lorenz (Lorenz) curve is the percentage of the number of health resources in different regions and is sorted according to their size. The horizontal axis is the percentage of the population involved in the corresponding area, and each point is connected to a Lorenz curve. .45 diagonal as a reference line, also called a fair line. If the allocation of health resources is closer to fairness, the curve is closer to the fair line (45 degree diagonal); conversely, it is far away from the fair line. The area enclosed by the absolute fair line and the Lorenz curve is a molecule, the area under the absolute equitable line is the denominator, and the ratio is called Gini. Coefficient. Gini coefficient is between 0 and 1. The more equitable distribution of resources in each region, the more the Gini coefficient is closer to 0; conversely, the Gini coefficient is closer to 1. areas, the Gini coefficient is less than 0.2, the distribution of resources is more than 0.2 less than 0.3, the resource distribution is reasonable, the Gini coefficient is greater than 0.3 less than 0.4. The source distribution gap is large, the Gini coefficient is more than 0.4 less than 0.5, the resource distribution gap is very wide, the Gini coefficient is 0.5, the resource distribution is in the high unfair risk state, the Gini coefficient is larger than 0.6. international general 0.4 as the "warning line". All data are statistically analyzed using SPSS13.0 and Excel2007. Results: 1 Hebei province is from 11 prefecture level. The city is composed of about 188 thousand and 800 square kilometers with a total area of 73 million 837 thousand and 500 residents, 49.33% of the urban population, 50.67% for the rural population, 50.67% in the rural population, 1.03:1 for men and women, 6 million 770 thousand and 900 in the permanent population, accounting for 9.17% of the total population, and 13 million 143 thousand for 14 years old, and 17.80% of the population. The total GDP of Hebei Province in 22014 has reached 29421.1. 500 million yuan per capita in 2013 was 2 trillion and 844 billion 295 million yuan.2014 per capita of 39984 yuan; the per capita disposable income of urban residents was 24141.34, rural residents were 10186.14, urban residents' family Engel coefficient was 26.17%, rural households were 29.36%; 3 our province had 78906 medical institutions, 1341 hospitals of traditional Chinese medicine, 894 in comprehensive hospitals, and grass-roots medical machines. 75624, including health centers 1960, community health service center 1169, professional public health institutions 1667., the number of comprehensive hospitals in our province is up to 894, the number of traditional Chinese medicine hospitals and specialist hospitals is small. The proportion of traditional Chinese medicine hospital is the smallest, accounting for only 0.2%. 4 Hebei province all medical and health service institutions have 322909 beds, of which there are 236889 hospitals, 73108 medical and health institutions, 11907 professional public health institutions, and the distribution of beds in each area, such as table5, the bed number is most concentrated in Shijiazhuang, Handan, Baoding, Qinhuangdao Hengshui medical treatment. The number of institutional beds is less. There are 157725 doctors in Hebei province. The number of doctors in Shijiazhuang is the most, the number of doctors in Shijiazhuang is the most, the number of Zhangjiakou doctors is only 7352, the number of practitioners in Shijiazhuang Qinhuangdao is higher, the specific details are table6, and the number of nurses in Shijiazhuang is up to 22773; 5 Hebei Province medical and health resources allocation number, such as The number of practitioners and the number of registered nurses are significantly related to the number of population. According to the formula, we can predict the number of changes in the number of people in the next five years, the number of licensed physicians, the number of registered nurses, and the number of vitality beds in eleven cities in Hebei Province, the number of practicing physicians and the fair number of nurses. The Gini coefficient of sex according to the resident population is 0.1462,0.1132,0.1346, both are less than 0.2, and the fairness is better. Conclusion: from the point of view of population demand and regional distribution, Hebei medical and health service resources can adapt to the basic needs of residents' medical health, the distribution of medical health resources is relatively balanced and fair. There is a certain linear relationship between the number of raw resources and the number of population, which is greatly influenced by the population strategy factors. In the future, the change of population and the influence of population strategy should be taken into consideration in optimizing the allocation of health resources. The establishment of medical and health service institutions should be adjusted and incrementally adjusted with the change of family planning policy and the development of the population aging. Consider social economic, financial input, health care policy changes and other factors to ensure the implementation of the plan.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.1

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