| "County"is an administrative unit at the grass-roots level in China,as well as the important carrier for realizing the goals of"Healthy China 2030".Government emphasized in13th Five-Year Planning for Health Service that"Serious Illness will be covered in county by 2020",which aiming at improve the comprehensive ability of primary medical services and realizing the goal of"Basic Medical and Health Service for all".However,how should health resources be allocated?How much is configured?Where’s the match?It has always been the topic concerned by government,public and academia.The county’s medical service system is composed of public hospitals,private hospitals,and community health service institutions,forming a multi-tiered,multi-type and multi-functional medical security network include county’s,town’s,village’s institutions.However,due to inadequate investment in health resources and imbalance allocation of resources,dislocation of function is a one of serious problems in county’s medical service system.The demand for medical services will be further released under the aged tendency,accelerating process of urbanization,increasing residents’income and health awareness.If grass-roots health resources cannot be rationally and effectively allocated,the contradiction between supply and demand of medical services may become more prominent.Therefore,this study selected Jianyang as an empirical case after comprehensively considering the urbanization process,aging tendency,household disposable income,medical service upgrading demand and other factors.Hoping to analyze and refine the common problems,to design a resource allocation method and optimization strategy accord with the characteristics of county medical system in China.This study mainly focuses on four aspects of empirical and theoretical research:1)Overall goal and sub-goal design of medical resource allocation and optimization.2)Optimization strategy of spatial distribution of medical resources in county area.3)Improving the"scale"and"technology"suitability of medical resources.4)Improving capacity and efficiency of county’s medical service system.In order to design the allocation and optimization target of medical resources from the perspective of"system optimization",the study used correlation analysis,grey prediction model G(1,1)and regression model to analyze the current situation of medical demands and future growth expectation in Jianyang,and used spatial technique and quadrant analysis to analyze fairness and efficiency of medical resource allocation indifferent areas,found that:1)the total medical demands maintain stable growth,but because of the difference of population structure and economic development level among different regions,the growth rate of medical service in different regions are quite different.2)Although the total allocation of county health resources has increased,the imbalance between regional resource allocation and medical demand is prominent,and the phenomenon of"insufficient supply"and"insufficient demand"coexist.Therefore,this study has determined three directions of resource allocation and optimization,that is,to improve"Fairness and Accessibility","Adaptability"and"Ability and Efficiency".In the aspect of improving"Fairness and Accessibility",this research analyzes the adaptability of medical demand and supply and clinical discipline allocation in different areas based on the spatial accessibility.Collected the data about 74 medical institutions’geographical coordinates,roads and traffic network,distance and time for medical treatment in Jianyang,and using M2SFCA method to calculate the accessibility coefficient and the available distance of different clinical specialty services.It is found that the medical accessibility of Jianyang is concentric circular distribution.The spatial accessibility coefficients(_iA~G)of urban area and surrounding residents are higher than 9.0,while _iA~G of 22 residential areas located in"Agricultural area"are lower than 4.4.In addition,there are significant regional differences in the allocation of resources of clinical disciplines.The medical resources such as Ophthalmology,ENT,Stomatology,Rehabilitation and Emergency is too concentrated and the accessibility is relatively poor.As the perspective of narrowing the differences in medical resources allocation between urban and rural areas,this study used GIS to accurately identify the poor and the unbalanced areas of clinical discipline allocation depend on the spatial geographical distribution of medical resources.It is suggested to use GIS to improve the precision of medical resource planning and enhance the synergy of regional clinical discipline allocation.In the aspect of improving health resource"adaptation",author believe that health service is a special area need to concern about"timeliness"and"technically",so the efficiency of patients’access to medical services and the coverage of disease-specific technologies should be included in the health planning indicators.About"timeliness"application,author used single-channel and multi-channel queuing model to calculate the reasonable health human resources and bed resources allocation by using the KPI of"less than 15 minutes"waiting time for outpatient services and"less than 1 day"waiting time for admission.It is concluded that Jian Yang needs to increase the number of doctors by 929,and the number of new medical beds by 1855.About"technically"application,a case-combination model based on ICD-10was established to evaluate the medical technology from three aspects including"capacity","efficiency"and"quality"of medical service.By calculating the number of sub-groups of disease classification,CMI,cost-time index,low-risk case mortality.This study believe that the capacity,efficiency and quality of medical services in most areas have greater room for improvement.In the aspect of improving the whole level of county’s medical system,author believe medical institutions are not isolated,there is both competition and cooperation.From the view of system theory,the regional medical system can be regarded as a compound system.Through the scientific combination and distribution of health resources,the overall efficiency will be greater than the sum of the effectiveness of individuals.So,according to the characteristics of the geographical distribution,and the function and technical ability,this study divided the medical institutions into five regional medical groups.Then using linear programming model and queuing model to demonstrate the efficiency of regional medical cooperation model.The results showed that on condition of"seeking advanced medical treatment",the distance of medical treatment per patient increased by 49%,and the average time increased 42%.Under the same basic assumptions,such as total regional medical needs,waiting time for medical service,number of medical institution settings,and workload,suggesting that the coordination model can effectively enhance the overall medical service system’s capacity and efficiency.According to the above conclusions,using the basic principles of the theory of synergy,author discussed the strategies of Hierarchical Medical System,Insurance Payment Reform,Regional Diagnostic Centers,Medical Supply Chain from hindering or promoting regional cooperation.It is believed that it is necessary to establish a good cooperative mechanism.Different from the traditional researches which making regional health resource planning based on the static indexes,this study regards the county medical system as a complex and dynamic system.In order to integrate"welfare","timeliness"and"technically"into county’s health resource allocation planning,author have used a large number of theoretical and technical analysis methods,such as GIS,Linear Regression,Queuing Model,Case Combination Index,Collaborative Theory Model and so on.Hopes to give constructive suggestions on building a county’s medical system from a system level of"Accessible","Suitable"and"Efficient".These research methods and conclusions have strong innovative and practical value for enriching the theory of regional medical resource allocation for our country,especially at the beginning of the 14th Five-year Plan,China has embarked on a new journey to build a modern socialist country. |
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