監(jiān)測地區(qū)產(chǎn)科資源配置和利用現(xiàn)狀及公平性研究
發(fā)布時間：2018-10-23 16:07
【摘要】：研究目的通過分析監(jiān)測地區(qū)各類助產(chǎn)機構(gòu)產(chǎn)科資源配置和利用現(xiàn)狀以及產(chǎn)科資源分布的公平性,來評價監(jiān)測地區(qū)產(chǎn)科資源配置是否充足合理。為合理配置產(chǎn)科資源提供數(shù)據(jù)依據(jù),也為各地應(yīng)對生育政策的調(diào)整提供政策建議。研究方法利用中國疾病預(yù)防控制中心婦幼保健中心開展的調(diào)整完善生育政策對婦幼健康服務(wù)影響監(jiān)測項目所收集的監(jiān)測信息,對我國4個監(jiān)測地區(qū)全部助產(chǎn)機構(gòu)的產(chǎn)科資源配置情況進行分析。統(tǒng)計描述產(chǎn)科資源配置和利用情況以及變化趨勢,采用供需評價法對監(jiān)測地區(qū)產(chǎn)科床位的供需狀態(tài)進行評價,利用洛倫茲曲線、基尼系數(shù)和泰爾指數(shù)分析評價監(jiān)測地區(qū)產(chǎn)科資源配置的公平性。研究結(jié)果2013年監(jiān)測地區(qū)每千常住人口擁有0.27張產(chǎn)科床位、0.12名產(chǎn)科醫(yī)生、0.23名產(chǎn)科護士(其中含有0.08名助產(chǎn)士)；每平方公里擁有0.50張產(chǎn)科床位、0.22名產(chǎn)科醫(yī)生和0.44名產(chǎn)科護士(其中含有0.15名助產(chǎn)士)；供需評價法發(fā)現(xiàn)監(jiān)測地區(qū)產(chǎn)科床位的供需比為1.10,處于基本平衡狀態(tài)。2013-2015年開放床位呈現(xiàn)逐年增加的趨勢,2015年比2013年增長2.13%。監(jiān)測地區(qū)平均開放11815張產(chǎn)科床位,不同等級助產(chǎn)機構(gòu)中,三級助產(chǎn)機構(gòu)所占比例最高(46.93%),其次是二級助產(chǎn)機構(gòu)(34.97%),一級及未評級助產(chǎn)機構(gòu)所占比例最低(18.10%)；各級助產(chǎn)機構(gòu)以三級助產(chǎn)機構(gòu)的床位使用率最高(95.77%),二級次之(74.90%),一級及未評級最低(54.16%)；不同類別助產(chǎn)機構(gòu)中,以婦幼保健院(94.10%)床位使用率最高,綜合醫(yī)院次之(86.99%),社區(qū)／鄉(xiāng)鎮(zhèn)衛(wèi)生院最低(26.36%)。監(jiān)測地區(qū)共有14960名產(chǎn)科醫(yī)護人員,不同等級助產(chǎn)機構(gòu)中,三級、二級和一級及未評級分別占48.99%、34.08%和16.93%,分別承擔(dān)了54.24%、33.68%和12.08%的分娩量和53.47%、33.94%和12.59%的門診量。各級助產(chǎn)機構(gòu)的醫(yī)護比分別為1：2.05、1：1.88和1：1.77,床護比分別為1：0.88、1：0.81和1：0.75。每千活產(chǎn)擁有的產(chǎn)科醫(yī)生數(shù)、護士數(shù)及助產(chǎn)士數(shù)均以三級助產(chǎn)機構(gòu)最少(分別為7.74、15.98和5.59),二級次之(分別為9.31、17.52和6.57),一級及未評級最多(分別為13.31、23.52和7.69)。不同類別助產(chǎn)機構(gòu)中,以婦幼保健院每千活產(chǎn)擁有的醫(yī)護人員數(shù)最少。不同等級助產(chǎn)機構(gòu)中,以三級助產(chǎn)機構(gòu)產(chǎn)科醫(yī)護人員的工作負荷最重,產(chǎn)科醫(yī)生的人均年助產(chǎn)服務(wù)效率、人均年門診量和人均年擔(dān)負床日分別高達191.28、2765.56人次/人/年和1046.74床日/人/年,一級及未評級最低,三類指標分別為75.16、1233.26人次/人/年和436.12床日/人/年；不同類別助產(chǎn)機構(gòu)中,以婦幼保健院產(chǎn)科醫(yī)護人員的工作負荷最重,社區(qū)/鄉(xiāng)鎮(zhèn)衛(wèi)生院的工作負荷最輕。監(jiān)測地區(qū)各產(chǎn)科資源按孕產(chǎn)婦分布的基尼系數(shù)均小于0.3；按戶籍人口分布,產(chǎn)科床位、產(chǎn)科醫(yī)生和助產(chǎn)士的基尼系數(shù)在0.3-0.4之間,而產(chǎn)科護士的基尼系數(shù)為0.41；各產(chǎn)科資源按地理面積分布的基尼系數(shù)均在0.6以上。通過貢獻率分析發(fā)現(xiàn),各產(chǎn)科資源城市間的差異對監(jiān)測地區(qū)按地理分布不公平的影響僅占30%左右,城市內(nèi)的差異是引起不公平的主要原因。研究結(jié)論監(jiān)測地區(qū)每千人口和每平方公里產(chǎn)科資源配置水平雖高于全國平均水平,但仍低于部分中低等收入國家,產(chǎn)科資源相對不足。與此同時,存在著產(chǎn)科資源在各類助產(chǎn)機構(gòu)(不同等級、不同類別)間分布不合理的問題,其中三級助產(chǎn)機構(gòu)和婦幼保健院的產(chǎn)科資源相對不足,且處于超負荷利用狀態(tài)；基層助產(chǎn)機構(gòu)(一級及未評級助產(chǎn)機構(gòu)、社區(qū)/鄉(xiāng)鎮(zhèn)衛(wèi)生院等)產(chǎn)科床位使用率偏低,工作負荷也相對較輕,部分產(chǎn)科資源處于閑置狀態(tài)。監(jiān)測地區(qū)產(chǎn)科資源在地理分布上也存在著嚴重的公平性問題,從而影響產(chǎn)科資源的利用效率和地理可及性。建議適當(dāng)增加產(chǎn)科資源數(shù)量,并調(diào)整產(chǎn)科資源在各類助產(chǎn)機構(gòu)間的配置,加強落實分級診療制度,同時在產(chǎn)科資源配置時考慮地理的可及性。
[Abstract]:Objective To evaluate the adequacy and rationality of obstetric resources allocation in monitoring areas by analyzing the status of obstetric resources allocation and utilization and the equity of obstetric resources distribution in various midwifery institutions in the area. To provide data basis for rational allocation of obstetric resources, policy recommendations are also provided for the adjustment of fertility policies throughout the country. Methods The monitoring information collected by maternal and child health care center of China Center for Disease Control and Prevention was used to monitor the monitoring information collected by maternal and child health services, and to analyze the distribution of obstetric resources in all midwifery institutions in four monitoring areas in China. The supply and demand status of obstetric beds in the monitoring areas were evaluated by means of supply and demand evaluation, and the fairness of obstetric resources allocation in monitoring areas was evaluated by means of logistic curve, Gini coefficient and Terkel index. The results of the study included a total of 0. 27 obstetric beds per thousand inhabitants in 2013, 0,12 obstetricians, 0. 23 obstetric nurses (including 0. 08 midwives); 0. 50 obstetric beds per square kilometre, 0,22 obstetricians and 0,44 obstetricians (including 0. 15 midwives); The supply and demand evaluation method found that the supply and demand ratio of obstetric beds in the monitoring area was 1. 10, which was in the basic balance state. In 2013-2015, the open bed showed a trend of increasing year by year, which increased by 2.13% in 2015 than in 2013. The average open 11815 obstetric beds in the monitoring area, with the highest proportion of three-stage midwifery institutions (46. 93%), followed by secondary midwifery (34.97%), the lowest percentage of the primary and non-rated midwifery institutions (18.10%); The highest utilization rate (95. 77%), second order (74. 90%), primary and non-rated lowest (54. 16%) in midwifery institutions at all levels; in different types of midwifery institutions, the highest utilization rate of beds in maternal and child health care (94.1%) was the second (86. 99%). Community/ township health centers (26. 36%). There were 14,960 obstetrical and medical personnel in the surveillance area, with the three levels, secondary and primary and non-rated at 48. 99%, 34. 08% and 16.93%, respectively, with 54,24%, 33.68% and 12.08% of parturition and 53. 47%, 33.94% and 12.59% of outpatient. The ratio of medical care ratio of midwifery institutions at all levels was 1: 2.05, 1: 1.88 and 1: 1.77, respectively. The bed protection ratio was 1: 0. 88, 1: 0. 81 and 1: 0. 75, respectively. The number of obstetricians per thousand live births, the number of nurses and the number of midwives were the least (7.74, 15.98 and 5.59), followed by level two (9.31, 17.52 and 6.57, respectively), and the highest and unrated (13. 31, 23. 52 and 7. 69, respectively). In different types of midwifery institutions, the number of health care workers per 1,000 live births in the Maternal and Child Health Care Hospital is the least. In different grade midwifery institutions, the work load of obstetric care workers in three-stage midwifery institutions is the heaviest, the per-capita annual attendance rate of obstetricians, the per capita annual outpatient service and the average annual per capita per capita are 191. 28, 2765. 56 times per person/ year and 1046. 74 beds day/ person/ year, the first and the non-rated lowest, Three kinds of indicators were 75. 16, 1233. 26 person-time/ person/ year and 436. 12 bed days per person/ year respectively; in different kinds of midwifery institutions, the workload of obstetric care workers in MCH hospital was the heaviest, and the workload of community/ township health centers was the most light. According to the distribution of household registration population, obstetric beds, obstetrician and midwife, the basic Nini coefficient of obstetric nurses was 0. 3-0. 4, while the basic Nini coefficient of obstetric nurses was 0. 41; The Gini coefficient of every obstetric resource distribution according to geographical area is above 0. 6. Through the analysis of the contribution rate, the difference in the urban areas of the obstetric resources accounts for only about 30% of the geographical distribution of the monitoring areas, and the difference in the cities is the main cause of injustice. The results showed that the distribution level of obstetric resources in every 1000 and per square kilometre in the monitoring area was higher than that of the national average, but still lower than those in the middle and lower income countries, and the obstetric resources were relatively inadequate. At the same time, there is an unreasonable distribution of obstetric resources among various midwifery institutions (different grades and different categories), among which the obstetric resources of the three-level midwifery and maternal and child health clinics are relatively inadequate and are in an overload state; The utilization rate of obstetric beds in the grassroots midwifery institutions (primary and non-graded midwifery institutions, community/ township hospitals, etc.) is low, and the workload is relatively light, and some of the obstetric resources are in an idle state. There are serious fairness problems in the geographical distribution of obstetric resources in the monitoring area, thus affecting the utilization efficiency and geographical accessibility of the obstetric resources. It is recommended that the number of obstetric resources be increased appropriately, and the allocation of obstetric resources among various midwifery institutions should be adjusted to strengthen the implementation of the hierarchical diagnosis and treatment system, while taking into account the geographical accessibility in the allocation of obstetric resources.
【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R17
本文編號：2289752
[Abstract]:Objective To evaluate the adequacy and rationality of obstetric resources allocation in monitoring areas by analyzing the status of obstetric resources allocation and utilization and the equity of obstetric resources distribution in various midwifery institutions in the area. To provide data basis for rational allocation of obstetric resources, policy recommendations are also provided for the adjustment of fertility policies throughout the country. Methods The monitoring information collected by maternal and child health care center of China Center for Disease Control and Prevention was used to monitor the monitoring information collected by maternal and child health services, and to analyze the distribution of obstetric resources in all midwifery institutions in four monitoring areas in China. The supply and demand status of obstetric beds in the monitoring areas were evaluated by means of supply and demand evaluation, and the fairness of obstetric resources allocation in monitoring areas was evaluated by means of logistic curve, Gini coefficient and Terkel index. The results of the study included a total of 0. 27 obstetric beds per thousand inhabitants in 2013, 0,12 obstetricians, 0. 23 obstetric nurses (including 0. 08 midwives); 0. 50 obstetric beds per square kilometre, 0,22 obstetricians and 0,44 obstetricians (including 0. 15 midwives); The supply and demand evaluation method found that the supply and demand ratio of obstetric beds in the monitoring area was 1. 10, which was in the basic balance state. In 2013-2015, the open bed showed a trend of increasing year by year, which increased by 2.13% in 2015 than in 2013. The average open 11815 obstetric beds in the monitoring area, with the highest proportion of three-stage midwifery institutions (46. 93%), followed by secondary midwifery (34.97%), the lowest percentage of the primary and non-rated midwifery institutions (18.10%); The highest utilization rate (95. 77%), second order (74. 90%), primary and non-rated lowest (54. 16%) in midwifery institutions at all levels; in different types of midwifery institutions, the highest utilization rate of beds in maternal and child health care (94.1%) was the second (86. 99%). Community/ township health centers (26. 36%). There were 14,960 obstetrical and medical personnel in the surveillance area, with the three levels, secondary and primary and non-rated at 48. 99%, 34. 08% and 16.93%, respectively, with 54,24%, 33.68% and 12.08% of parturition and 53. 47%, 33.94% and 12.59% of outpatient. The ratio of medical care ratio of midwifery institutions at all levels was 1: 2.05, 1: 1.88 and 1: 1.77, respectively. The bed protection ratio was 1: 0. 88, 1: 0. 81 and 1: 0. 75, respectively. The number of obstetricians per thousand live births, the number of nurses and the number of midwives were the least (7.74, 15.98 and 5.59), followed by level two (9.31, 17.52 and 6.57, respectively), and the highest and unrated (13. 31, 23. 52 and 7. 69, respectively). In different types of midwifery institutions, the number of health care workers per 1,000 live births in the Maternal and Child Health Care Hospital is the least. In different grade midwifery institutions, the work load of obstetric care workers in three-stage midwifery institutions is the heaviest, the per-capita annual attendance rate of obstetricians, the per capita annual outpatient service and the average annual per capita per capita are 191. 28, 2765. 56 times per person/ year and 1046. 74 beds day/ person/ year, the first and the non-rated lowest, Three kinds of indicators were 75. 16, 1233. 26 person-time/ person/ year and 436. 12 bed days per person/ year respectively; in different kinds of midwifery institutions, the workload of obstetric care workers in MCH hospital was the heaviest, and the workload of community/ township health centers was the most light. According to the distribution of household registration population, obstetric beds, obstetrician and midwife, the basic Nini coefficient of obstetric nurses was 0. 3-0. 4, while the basic Nini coefficient of obstetric nurses was 0. 41; The Gini coefficient of every obstetric resource distribution according to geographical area is above 0. 6. Through the analysis of the contribution rate, the difference in the urban areas of the obstetric resources accounts for only about 30% of the geographical distribution of the monitoring areas, and the difference in the cities is the main cause of injustice. The results showed that the distribution level of obstetric resources in every 1000 and per square kilometre in the monitoring area was higher than that of the national average, but still lower than those in the middle and lower income countries, and the obstetric resources were relatively inadequate. At the same time, there is an unreasonable distribution of obstetric resources among various midwifery institutions (different grades and different categories), among which the obstetric resources of the three-level midwifery and maternal and child health clinics are relatively inadequate and are in an overload state; The utilization rate of obstetric beds in the grassroots midwifery institutions (primary and non-graded midwifery institutions, community/ township hospitals, etc.) is low, and the workload is relatively light, and some of the obstetric resources are in an idle state. There are serious fairness problems in the geographical distribution of obstetric resources in the monitoring area, thus affecting the utilization efficiency and geographical accessibility of the obstetric resources. It is recommended that the number of obstetric resources be increased appropriately, and the allocation of obstetric resources among various midwifery institutions should be adjusted to strengthen the implementation of the hierarchical diagnosis and treatment system, while taking into account the geographical accessibility in the allocation of obstetric resources.
【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R17
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