| Purpose: In order to clarify the situation of coupling coordination development of medical resources allocation and economy,promote optimal allocation of medical resources and improve medical services in China,this study starts from the current situation of medical resource allocation in China,combines with relevant data on economic development,evaluates the allocation of medical resources and economic development from a dynamic perspective,explores the characteristics of coordination development and the prominent problems between the two,and puts forward targeted recommendations and policies.Methods: Descriptive statistical analysis method was used to understand the current situation of medical resource allocation in China from three perspectives:institutions,regions,and urban-rural areas.The dynamic evaluation method based on the TOPSIS was adopted to comprehensively analyze and evaluate the difference and growth of medical resource allocation and economic development from the dimensions of research objects,research indicators,and time.and the Granger causality test was used to quantitatively verify the coupling relationship between medical resource allocation and economic development.The relative development degree model was used to measure the relative development situation of the medical resource allocation and economic development.The modified coupling coordination degree model was used to explore the coordination development situation of the two subsystems,and the spatial evolution trend of the coupling coordination development was analyzed by using the spatial statistical method of standard deviation ellipse.Results: 1.Current situation of medical resource allocation:(1)Analysis of the current situation of medical resource allocation among medical and health institutions showed that the total number and development speed of medical technical personnel in hospitals were superior to those in primary medical and health institutions during 2012-2020,and hospitals also had obvious advantages in personnel quality and professional level.The income of hospitals is much higher than that of primary medical and health institutions,and the growth rate is basically the same during the study period.The proportion of fiscal income in the total income of the two types of institutions keeps rising,and primary medical and health institutions are more dependent on national finance than hospitals.The quality and quantity of hospital beds and equipment are obviously better than that of primary medical and health institutions,and the gap is deepening.(2)The analysis results of the current situation of medical resource allocation among regions showed that the total number of health technicians in eastern region > central region > western region,and the per capita data in western region >eastern region > central region,with significant differences within each region.The total medical income,financial subsidy income and medical income/career income of the eastern region are much higher than those of the central and western regions.The total medical income,medical income/career income of the central region is higher than that of the western region,but the financial subsidy income of the central region is lower than that of the western region.The number of medical and health institutions and the number of beds in the total number of regions from high to low is eastern region,central region,western region,in which the total number of medical and health institutions between the middle and western regions is relatively small,and the development of the provinces within the region is relatively large.(3)In terms of total quantity,the gap between urban and rural health technicians is not obvious.In terms of development speed,urban is faster than rural,and the gap between urban and rural human resources is gradually increasing.From the per capita level,there is a huge gap between the number of health technicians of 1,000 people between urban and rural areas,which has been narrowing in recent years,but the imbalance has not been significantly improved.The number of urban hospitals increased faster than rural areas,and the number of urban primary medical and health institutions increased faster,while rural areas were in the stage of structural adjustment.The total number of beds between urban and rural areas was not obvious,and the per capita number of beds in urban areas was much higher than that in rural areas.2.The dynamic comprehensive evaluation results of medical resource allocation and economic development show that:(1)In terms of indicator values difference evaluation,the regions with high level of medical resource allocation are concentrated in Beijing,Shanghai,Qinghai,Tibet,Jiangsu,Zhejiang,Hainan and other places,mainly in the eastern region,while the regions with low level are concentrated in Anhui,Jiangxi,Henan,Hubei,Guangdong,Guangxi,Chongqing,Yunnan and mainly in the central region;Guangdong,Jiangsu,Zhejiang and Shandong have always been at the forefront of China’s economic development,while Tibet,Gansu,Qinghai,Ningxia and Hainan have remained in the bottom five.(2)In terms of the indicator values growth evaluation,the provinces with fast growth in medical resource allocation are Shanghai,Jiangsu,Zhejiang,Hainan and Tibet,mainly in the eastern region,while the regions with slow growth are Tibet,Yunnan,Shaanxi,Hebei,Heilongjiang,Shanxi,Qinghai and Zhejiang,mainly in the western region.The provinces with the highest economic growth rate are Jiangsu and Guangdong,and the bottom provinces in the research period are Tibet,Heilongjiang,Liaoning,Liaoning,Shanxi,Inner Mongolia,Shandong and Hubei,and the east and central regions are mainly.(3)The comprehensive evaluation results showed that the high-value areas of the comprehensive evaluation results of medical resource allocation from 2012 to 2020 were concentrated in Beijing,Shanghai,Jiangsu,Zhejiang,Hainan,Tibet,Gansu and other places,mainly in the eastern part of China,and the level of medical resource allocation ranked first in China.In the study period,the lowest comprehensive evaluation value was concentrated in Anhui,Jiangxi,Henan,Yunnan and other places,mainly in the central region.The economic development of Jiangsu Province and Guangdong Province has always been in the forefront of China,and the overall level is the highest,and the development situation is improving.The provinces with the lowest results of comprehensive evaluation of economic development from 2012 to 2020 were concentrated in Tibet,Gansu and Qinghai,showing a distribution pattern of "high in the east and low in the west".3.Coupling coordination development results show:(1)The degree of coupling between medical resource allocation and economy is concentrated in four stages: antagonistic development,run-in development,high-level coupling development and benign resonance development.The proportion of provinces in 2012 was 3.23%,38.71%,54.84% and 3.23%,and that in 2020 was 3.23%,58.06%,32.26% and 6.45%,and the overall coupling degree was degraded from high level coupling development to run-in development.(2)The proportion of provinces in the coordination degree of medical resource allocation and economic coupling developed from mild disorder(51.61%),near disorder(41.94%)and barely coordination(6.45%)in 2012 to near disorder(48.39%),barely coordination(45.16%)and primary coordination(6.45%)in 2020.Unbalanced development among regions has been improved,and coordination development has been further deepened.From the perspective of space,the center of gravity of coupling coordination development moves southeast first,then southwest,and develops southeast as a whole.The ellipse area of standard deviation of coupling coordination degree decreases gradually,and the coupling coordination degree appears "agglomeration" in space,and the improvement of coordination development level is concentrated in a few areas.The rotation Angle of the standard deviation ellipse shrinks and the pattern of "northeast-southwest" deepens.The standard deviation of the major axis and the minor axis of the ellipse showed a decreasing trend,and the coupling coordination degree showed a polarization trend.Conclusions: 1.The unbalanced distribution of medical resources is prominent and the overall improvement is limited.The development gap between medical and health institutions,between regions,and between urban and rural areas is large,and the degree of imbalance is further deepening.From 2012 to 2020,the level of medical resource allocation appears polarization between regions and within regions,and the development changes of provinces fluctuate frequently.Some regions have significantly declined in ranking,lagging behind the improvement of the overall medical service level of the country.2.The allocation of medical resources and the coordinated development of economic coupling are kept at a low level.From 2012 to2020,the coupling coordination degree of all regions increased to varying degrees,but the overall coordinated development is still not realized.The main reason is that the development level gap between systems is too large,it is difficult to form coupling effect between each other,which restricts the improvement of the coordinated development level.3.The spatial change trend of coupling coordination development is obvious,and the spatial pattern is gradually deepened.The results of standard deviation ellipse showed that the center of gravity shifted to the southeast,and the change of coupling coordination degree concentrated in some regions.The overall development speed of resource-rich regions was significantly faster than that of other regions,and the spatial pattern was further deepened.Based on the above research results,corresponding countermeasures and suggestions are put forward: 1.Optimize the allocation of medical resources to achieve balanced improvement of medical service level.In the meantime,developed regions should carry out assistance work and provide matching assistance to areas with weak development,so as to narrow the gap in medical resource allocation.2.Advocate the coordinated development of medical resource allocation and regional economy.The allocation and supply of medical resources should be based on the current level of regional economic development and maintain a certain level of relative development of medical resources allocation,so as to avoid excessive local financial burden and restriction of coordinated development due to the advanced and lagged supply of medical resources allocation which is not compatible with economic development.3.Explore regional development paths according to local conditions to reduce spatial heterogeneity.The scale of local finance fundamentally determines the input of medical resources.Regions with rapid coordinated development and improvement rely on the advantages of economic resources of local development.All regions need to combine their own characteristics to improve the overall level of economic development and create a favorable environment for coordinated development. |
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