| Objectives:To describe the the present situation for the allocation of health resources and health services utilization of residents in Changsha city in the yeay of2011and to analysis of existing problems; and to evaluate the fairness and balance of health resources distribution and to understand the health resources utilization in Changsha city; Using the method of health service demand (need), service target, ARIMA model to predict the demand of health manpower and beds in Changsha city from2012to2015,and to analysis the challenges and opportunities facing the health resource allocation and to develop suggestions for the optimal allocation of health resources in Changsha city.Methods:Both qualitative and quantitative method for allocation of health resources in Changsha city were conducted. Data for health resources from institutions was collected through survey, and descriptive analysis method was used in the city’s health institutions, health manpower, health beds and sanitation, region distribution, organization distribution, the number of health technical personnel’s quality (including age, record of formal schooling and title).Health resources change situation from2007to2011was described, and also descriptive analysis was performed in the total number of patients, the number of inpatients, and the status of the hospitalized d utilization in medical institutions in Changsha city. Based on the population distribution of health human resource, the Lorenz curve and Gini coefficient were used to the evaluate the fairness of health resource,and the balance of health human resources was evaluated with health density index; Household health interview was conducted to understand the residents’health services needs and demands, potential demand and utilization; The volume of the demands for health resource was predicted with the method of health service demand (need), service target, and ARIMA model,respectively.Results:(1) The results from the status of allocation of health resources showed as follow.Health institutions:By the end of2011, there were the total of4339medical and health institutions at various levels in Changsha city; From2007to2011, the number of health facilities were on the rise in general; Among the most number of health facilities were located in Yuhua district, and the least number in the Wangcheng district; The majority of health institutions was run by collective ownership accounted for66.10%,and health agencies were managed by the health sector and social cost, accounted for32.47%,32.59%,respectively.Health workforce:By the end of2011, in Changsha city, health enterprise, there were total of66104health employee including53030health technical personnel accounting for80.22%, health personnel per thousand population and health technical personnel per thousand population were9.32and7.48,respectively; From2007to2011, all kinds of health personnel were on the rise, the number of the fastest growing was a nurse with the average annual growth rate of14.86%; And all kinds of health workers per thousand population were on the rise; Yuhua district was at the first place and Wangcheng district in last place. The proportion of the health officials, health technicians, doctors, nurses among total health personnel with66.5%,65.2%,58.6%,77.0%,58.6%were distributed in the hospital,respectively.The health technical personnel showed a trend of getting younger, most of them were younger than45years old. A total of19537(accounting for43.33%) health worker had undergraduate academic level,and64.28%of them were low professional title.Medical beds:by the end of2011, there were a total of47036medical beds in Changsha city with6.63beds per thousand population; From2007to2011, a trend of sustained growth was found in medical beds and beds per thousand population in the ownership was on the rise in general; the vast majority of medical beds were distributed in the hospitals with36679beds(accounting for77.98%); the most of medical beds and beds per thousand population were allocated in Yuhua district, while the least number in Wangcheng district.Health equipment:by the end of2011, a total of35386units were above ten thousand yuan with4.99units per thousand population; From2007to2011, the number and value all showed a trend of obvious rise over the five years and equipment units per thousand population run by ownership showed a trend of steady growth; A total of29132units equipment (accounting for82.33%) were mainly distributed in the hospitals and in the largest population density of district, which accounted for21.61%, and the least equipments at urban area accounting for1.52%.(2) Based on the population distribution, fairness on health resource allocation such as health manpower, medical beds in Changsha city were in moderate fair condition with gini coefficient were0.33,0.32,respectively. Equipment valued above ten thousand yuan was in unfair condition with the gini coefficient was0.42; The equity of health resources including health workers, health beds and equipment were the optimal fair in rural areas with gini coefficient0.08,0.08,0.05, respectively; The equity of health resources in urban area were moderate with gini coefficient is0.21,0.23,0.33, respectively; The equity of health technical personnel with graduate acdemic level or more was in a reasonably fair condition with gini coefficient0.37,but The equity of health technical personnel with medium-grade professional title or more was in unfair condition with gini coefficient0.45.(3) The equilibrium of health resources allocation was the highest in Furong district with health personnel density index73.16, and the lowest in Ningxiang county at2.48, and there were29.5times difference between two regions; The the highest and the lowest equilibrium of health beds resources were Furong and Wangcheng district with density index39.29and1.91,respectively; The same trends equilibrium of equipment valued above ten thousand yuan were also found in those two districts with density index50.92and0.76,respectively; There were an positive correlation for the density index among all kinds of indicators of health resources with the correlation coefficients greater than0.83.(4) Efficiency of health resources allocation results show that there were30.1445million people visiting clinical medical institutions in2011, and more than half of the residents selected seeing a dcotor in hospital; There were1.38million inpatients in general hospital and township hospital; Beds utilization rate of institutions were the highest in maternal and child health care, and relatively low in community health service institutions.(5) Household survey findings from health service demand, need and utilization indicated that two-week prevalence rate was13.77%, two-week consultant rate was7.95%, hospitalization rate was15.27%, and need to hospitalization rate was20.15%,respectively. Changsha residents prority to preferred to grassroots health institutions for outpatient sevice, and to hospitalized to county or city hospital.(6) Prediction findings from the health service demand (need) method, the ARIMA model, the service target method showed that doctor per thousand population in Changsha city in2015were1.66～2.62,3.12,4.55, respectively. Predict error (1.46%) from ARIMA model was the minimum; Health service demands (needs) method, the ARIMA model to were predicted that bed per thousand population were7.36～9.65and7.36, respectively. Relative error of ARIMA model to predict bed per thousand population was0.30%.Conclusions:(1) The volume of health resources allocation was increased year by year in Changsha city from2007to2011, all kinds of health resources growth presented good trends. By the end of2011, health technicians, health beds per thousand population, equipment valued ten thousand yuan were7.48,6.63,4.99respectively, the allocation of health resources could basically meet in Changsha residents’ health service demand, but the distribution of health resources was uneven, there were differences between town and country,and unbanlance on allocation implied that grassroots lack health resources, Insufficient health resources utilization and waste were coexistence. Distribution for health professionals was unreasonable, nurses lack in grass-roots rural areas,also Fewer senior professional titles were in Changsha city; Overall quality of rural doctors was not good; Bed utilization rate in maternal and child hospital with heavy work load was high; equipment utilization rate in urban institutions was high, but frequency apllication equipment in rural was low.(2) Prediction findings from the health service demand,health service need, the service target method and the ARIMA model showed that doctor per thousand population in Changsha city in2015were1.66,2.62,4.55,3.12, respectively. ARIMA model had the optimal prediction effect on the current situation of health personnel; Health service demand, health services need and ARIMA model were predicted that beds per thousand population were7.36,9.65,8.08, respectively.ARIMA model with the optimal prediction effect could better reflect the current health bed condition.(3) Two-week prevalence rate was13.77%, two-week consultant rate was7.95%hospitalization rate was15.27%, and need to hospitalization rate was20.15%. Changsha residents prority to preferred to grassroots health institutions for outpatient sevice. |
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