【作者】 冯毅；

【导师】 张瑾；

【作者基本信息】 重庆医科大学 ， 社会医学与卫生事业管理， 2007， 硕士

【摘要】 研究目的:卫生资源是开展卫生服务的前提和基础,卫生资源配置的合理与否决定着卫生资源有效利用的程度。实现卫生资源的合理配置,提高卫生资源的有效利用,是促进卫生事业协调、稳定、健康发展的重要条件。因此如何合理的配置卫生资源以及实施好区域卫生规划是各级卫生行政部门亟待解决的问题。重庆市也同全国其他大城市一样,在卫生资源配置和利用中存在着许多不合理之处。本研究根据1997~2004年《重庆市卫生统计资料汇编》、《重庆市统计年鉴》、《中国卫生统计年鉴》以及相关资料(卫生部公布的统计数据、国家卫生服务调查数据)来分析重庆市的卫生资源发展状况。以卫生资源为侧重点揭示重庆直辖以来卫生事业所取得的成绩与存在的突出问题,提出解决问题的建议和对策,为政府和卫生行政部门制定区域卫生发展规划和相应政策提供参考。研究内容与方法:1、卫生资源基本情况分析:分析评价1997~2004年重庆市卫生机构数、卫生人力、卫生经费、卫生物力(床位与设备)等资源的状况及变化趋势。主要分析指标有绝对数、平均发展速度、构成比、每千人口拥有资源数量等。2、卫生资源相关分析:分析评价重庆市1997~2004年间就诊人次、入院人数、床位数、卫生机构数、卫生人员数、大型医疗设备数量等主要卫生资源及其应用指标之间变化关系。主要分析方法为相关分析。3、卫生资源对比分析:将主要卫生资源与其它直辖市作比较分析;将重庆市卫生部门平均每所综合医院工作效率情况与全国平均水平作比较;比较分析重庆市城市与农村主要卫生资源配置以及疾病构成情况。主要分析方法为描述性对比分析方法和t检验。4、卫生资源配置公平性分析:对1998~2004年重庆市卫生资源配置的相关数据进行分析,对全市的40个区、县以及经济发展水平不同的三个区域:都市发达经济圈、渝西经济走廓和三峡库区生态经济区的医生、护士和病床的人口及地理分布的公平性进行了评价。主要分析指标为基尼系数和劳伦兹曲线。研究结果:1997年重庆直辖以来,卫生事业取得了快速的发展,建立了较为完善的城乡卫生服务网络,公共卫生体系初步建成,居民的健康指标显著提高,卫生服务的供给能力进一步增强。但在卫生事业快速发展的同时,随着医学模式的转变和群众健康需求的变化、医疗机构与卫生服务被推向市场,现行的卫生服务体系特别是在卫生资源配置与利用中存在的问题日益突出。分析重庆市卫生资源的现状,其问题主要表现在:(1)卫生资源存量与质量均不高且结构不合理,卫生人力资源学历偏低,职称、专业、设备结构存在诸多问题,医护比不合理,护理人员严重不足;(2)卫生资源城乡之间、区域之间配置不合理,发展不平衡,卫生资源地理分布的公平性差且有待提高;(3)基层卫生服务机构力量薄弱,与居民的卫生服务需要不相适应;(4)卫生资源利用率不高,由于农村诊疗人次下降导致总诊疗人次呈下降趋势,显示出农村居民的卫生服务需求受到抑制,医疗经济负担逐渐加重;(5)城乡居民的疾病谱已转变为非传染性慢性疾病,但相应的慢性病防治措施开展不力。上述问题是由多种原因所造成的,其中深层次的原因主要有以下几个方面:受历史及传统等因素的影响,卫生资源配置不合理,导致了资源不足与浪费并存;政府对卫生投入的力度减弱;观念误区导致对基层及农村卫生投入的倾斜政策并未得到落实;利益驱动继续导致费用上涨;医疗保障制度改革滞后,城市贫民与农村居民的卫生服务需求受到抑制;疾病模式的变化等。对策:加大区域卫生规划的实施力度,增加政府投入,调整存量,优化增量;加大卫生人力资源的培养力度;采取各种措施提高卫生资源的有效利用率;高度重视社区卫生服务,健全配套措施促进其可持续性发展;加强农村卫生工作,继续加大新型农村合作医疗的开展力度,切实解决好农民的防病和就医问题。更多还原

【Abstract】 Objective:Health resources is the premise and basis of health care service, the rational allocation of health resources decides the efficiency of the health resources. The most important condition for coordinated, stable, healthy development of health care is to realize the rational allocation and upgrade efficiency of health resources. Therefore for health administration sectors, how to optimize allocation of health resource and implement regional sanitation planning are main problems need to be solved. There are some problems of irrational allocation and utilization of health resources in Chongqing city as well as other big cities in our country. This research is to analyze, discuss situation of health resources development basing on the date of Chongqing health statistics yearbooks and Chongqing statistics yearbooks and China health statistics yearbooks and other connected date during 1997~2004. This paper represent the achievements and prominent problems of public health care in Chongqing city since it was upgraded to the municipality, give corresponding recommendations based on the analysis and conclusions, expecting to benefit the government and health administration sector on constituting regional sanitation development planning.Method:1、Fundamental situation analysis: To analysis the tendency of the numbers of Chongqing health organs, health human resources, health expenditure, beds and equipments by the methods of absolute number, average developing velocity, percentage, occupying quantity per thousand health resources etc.2、Correlation analysis: To analysis number of the patients, inpatients, beds, health organs, health human resources, large scale medical equipments etc by the method of partial correlation on the partial correlation mathematics’model, to find out the correlation degree of various health resources.3、Contradistinction analysis: To comparatively study the main health resources of four municipalities in china, to value Chongqing working efficiency and medical service of each comprehensive hospitals comparing with the national level, to comparatively study the allocation of various health resource in the city and countryside and composition situation of the diseases. This section analyses by descriptive contradistinction analysis and the t-test.4、Study on equity of health resources configuration: Based on statistical data from 1998 to 2004, the distribution equity of population and geography area of health resources of the whole city and the three regions with different economic levels was analyzed and evaluated by Gini coefficient and Lorenz curve.Result:Chongqing has been making a rapid development in health care since it was upgraded to the municipality in 1997. Perfect health service network throughout city and countryside has been constructed, public health system has been built up, resident’health indicators have significantly improved, ability to supply health service increased. Although Chongqing health care are developing in a rapid way, the problem in present health service system, especially how to rationally use and allocate the present health resource, has show out more obviously as marketing of the medical service and medical organs, the changes of the medical service models and the health requirement of people. We found that the main problems are as follows though analysis on the present situation of Chongqing health resource:(1)Not only the quantity of the present health resource is insufficient, but also quality is low. Furthermore, the framework is unreasonable. For example, the personnel’educational levels are on the low side, their professional posts are not rational, framework of personnel specialty and equipments is unreasonable, proportion of doctor and nurse is abnormal, nurses is seriously insufficient.(2)Health resource allocation between urban and rural areas is unreasonable, development among different regions is unbalance. The health resource distribution equity of geography area is low and needs to be improved.(3)The strength of the primary level medical institutions is weak, which can not suit health requirement of the resident.(4)The utilization of health resource is low, the visits to medical institutions in rural areas decreased induce that total patient’number is decreasing. These problems show that health service demand of rural resident is restrained, inhabitant’s medical economic burden aggravates gradually. (5)The types of the diseases of resident in urban and rural areas are changing to noninfectious and chronic ones, but the relative preventive measures are not enough. There are many reasons for the above problems, deep ones mainly they are:Under the influence of the history and tradition, irrational allocation of health resources has caused the phenomenon which health resources are insufficient and waste coexists, the insufficient input of government, a series of preferential policies to health care of rural areas do not implement due to wrong ideas, increased expenditure due to profit-making idea, layout of medical reform, depressed requirement of the urban poor and countryside inhabitant, change of disease model. Countermeasure:The government should strengthen regional sanitation planning implement, to increase its investment in public health care, to make allocation of health resource rational, to cultivate more health human resources, to make some measures on upgrading efficiency of health resources, to pay highly attention to community health service, to pushing the sustainable development of community health service by perfecting related assisting measures, to lay particular stress on rural health care, to guarantee that the new rural medical cooperation system develop in a healthy way, to set out the presents’problem of medical care.更多还原