| Objective: With the development of new-type urbanization, change of work and life styles and disease spectrum, as well as the aging society, the urban residents demand for health has significantly increased. In the construction of “Healthy China”,medical and health services are faced with new opportunities and challenges. Based on foreign experience of health reform and within the framework of the urban planning in Tianjin, this study aims to explore measures and suggestions to optimize the allocation of health resources, improve health service system including public health, health care service and medical insurance, in order to enhance health care system reform and the construction of “Healthy Tianjin”, and support the new-type urbanization for the city.Methods: The following methods were applied in this study:(1)Theoretical and empirical research: The theoretical studies on city development, supply side and demand side, public product, “Healthy City” and ecological medical model were conducted. By using empirical methods, the study explored the characteristics of health resources allocation in urbanized areas in Tianjin.(2) Qualitative and quantitative analysis: To study the need, demand and utilization of health service in urbanized areas, the health conditions of people were investigated by sampling survey methods. The Lorenz curve and Gini coefficient were used to analyze the equity of health resource allocation in Tianjin. The DEA–Tobit model was also employed to evaluate the efficiency and influencing factors of public hospitals in the urbanized areas.(3) Comparative and retrospective analysis: By adopting literature review, the related domestic and overseas literatures were summarized. The comparison of the effective measures of medical and health service in the process of urbanization in the United States, England, and Japan were carried out. China’s urbanization process and the development of health care system in Tianjin were retrospectively analyzed.Results:(1) The urbanization rate reached 82% and the number of migrant workers increased rapidly, with residents aged 65 and above accounting for 12.9% in Tianjin in 2013. Meanwhile, the features of employment structure of the region put forward new requirements to optimize the allocation of health resources.(2)Based onthe results of residents need, demand and utilization of health services in urbanized areas, 2-week morbidity rate and morbidity rate of chronic diseases were acquired,35.8% and 52.6% respectively, higher than that of rural area. The morbidity rates of young and middle-aged people were higher than the average level of the city and hypertension and diabetes were becoming increasingly popular. Seventy eight point five percent of patients would prefer to visit doctors in primary health care sectors,while the actual number was 40.8% due to insufficient service capability of these institutions.(3) In 2013, Tianjin spent 3.84% of its GDP on health care, below the national average of 5.57%, and the total health expenses mainly flowed to the city hospitals. The Gini coefficient of population in health resources was bellow 0.4, while the Gini coefficient of geography was more than 0.7, and the distribution of geography area indicating equality showed an even worse situation. The percentage of medical institutions funded by social capital reached 45.8%, while beds, medical staffs and patients treated in these institutions took up 16.1%, 13.4% and 17.1%,respectively.(4) The health resources per capita in the urbanized areas were lower than the city average, with the shortage of tertiary hospital in two districts and staffs of 14 sample community health service centers are 10.7% short.(5)Among 23 secondary and tertiary public hospitals, 47.8% hospitals were overall technically and scale inefficient. Twenty six point one percent were pure technically inefficient and nine manifested decreasing returns to scale. Hospital efficiency was positively related to bed occupancy rate, the ratio of medical personnel and the number of operations.Conclusions:(1) The health services in Tianjin are influenced by the changes of population and economic structure in the urbanization process.(2) Residents demand for health service in the urbanized areas presents a multi-level and diversified characteristic.(3)There are some problems in health service in the urbanized areas such as insufficient high quality health resource, unreasonable structure of total health expense layout and resource allocation. The hospitals funded by social capital provide limited services.(4)The health service system in the urbanized areas in Tianjin is far from perfection. Service capability of primary care and public health is poor and the efficiency of resource utilization needs improving.(5) Therefore, to improve healthservice system of Tianjin in the new-type urbanization process, the development strategies are put forward, which include adjusting the supply side structure,optimizing the resource allocation, perfecting the plan of medical institutions in the urbanized areas, and promoting the hardware and software upgrade of health service system. |
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