| Objectives1.This paper is aimed to optimize the structure of health resources index system by establishing the index system of health resources comply with Chinese characteristics and the requirements of the reform in our country.2.The paper grasp the total amount and structure of China's health resources allocation through dynamic analysis health resources allocation and health service supply3.The paper in order to system evaluate equity and efficiency of health resources allocation and health service supply by constructing the Chinese characteristics health resources allocation and health service supply fair-efficiency equilibrium model.4.The paper is aimed to explore the optimization strategy and the way of health resources allocation and health service supply equity and efficiency,providing policy advice to the national,provincial authorities and related medical institutions.Methods1.Boundary values method was used to establish index database of health resources.Delphi method was used to establish the index system of health resources comply with Chinese characteristics and the requirements of the reform in our country.2.Health service need method and health service demand method were used dynamic analysis balance between health resources allocation and health service supply including factors which affected the health demand.3.Comparative and descriptive analysis were selected to analyze health service supply situation from the perspective of suppliers and the influence of health service demand,need and utilization in different areas,age groups and disease system from the perspective of demanders.4.Gini coefficient was selected to analyze equity difference of health resource allocation and service between 31 provinces and cities in china.5.Network Data Envelopment Analysis was used to analyze efficiency difference of health resource allocation and service between 31 provinces and cities in china.6.The health resources allocation and health service supply fair-efficiency equilibrium model was constructed according to the factor analysis.7.Bootstrap and cluster analysis were used to judge the balance situation of fair-efficiency in health resources allocation and services supply of 31 provinces in China.Results1.In the terms of allocation of health resource:(1)After 3 rounds of Delphi expert consultation,the index system of health resources was optimized,which including 4 fist-level indicators,10 second-level indicators and 63 third-level indicators.From 1980 to 2015,the number of hospitals in China grew from 9 902 to 27 587,the number of professional public health institutions doubled.The number of licensed doctors increased from 1 153 234 to 3 039 153,and the number of registered nurses was about 1.1 times that of practicing doctors.By 2015,the number of rural doctors has shrunk to 27% of the original number,only about 1 031 525 people.In 2015,there were 10.21 health workers per thousand pupulation in urban areas,and only about 3.90 in rural areas.(2)From 1980 to 2015,the number of beds in China's medical and health institutions grew from 2.18 million to 7.01 million,the number of hospital beds increased from 1.20 million to 5.33 million.The number of beds per thousand population in medical institutions in China quadrupled,the number of beds per thousand agricultural population in township hospitals increased by only 0.29 in the past 35 years.2015 compared with 270.73 times in social health expenditure growth in 1980,government health spending increased with 240.33 times.The proportion of personal health expenditure decreased and social and government health expenditure increased.From 1990 to 2015,China's general hospital outpatient medical expenses per capita increased from 10.9 Yuan to 237.5 Yuan,of which the proportion of drugs decreased from 67.9% to 46.0%.Per capita medical expenses of inpatient patients increased from 473.3 Yuan to 8 953.3 Yuan,of which the proportion of drugs decreased from 55.1% to 36.5%.(3)In 1993,1998,2008,2013,China's hospital beds were in short supply.In1993,1998,2008,we had inadequate allocation of resident doctors.2.In the terms of health service supply:(1)From 1980 to 2015,the number of hospital visits increased from 1.05 billion persons to 3.08 billion persons,the number of hospital admissions increased from 22.47 million to 16.91 million people.The number of patients increased from 410 thousand to 19.46 million especially in China's traditional Chinese medicine hospital.(2)From 1993 to 2013,the two-week morbidity rate showed an upward trend,which were: 14.0%,15.0%,14.3%,and 24.1%,respectively.The two-week chronic diseases morbidity rate showed an upward trend,which was 20.7%,20.1%,18.8%,24.1% and 33.1%,respectively.Two-week medical consultation rate showed a slow decline,which were: 17%,16.4%,13.4% and 13.0%,respectively.The hospitalization rate of residents showed an upward trend,which were 3.6%,3.5%,3.6%,6.8% and 9.0%,respectively.The average length of stay in urban areas was reduced from 30.0 to 12.5 days,and the average length of stay in rural areas decreased from 14.0 to 10.7 days.3.In the study of health resources allocation and health service supply equity and efficiency:(1)The Gini coefficient of health resources and service allocating by population and geographical for medical institutions was 0.23-0.27 and 0.42-0.71 respectively.The Gini coefficient range of bed resources was 0.10-0.36 and 0.52-0.82 separately.The Gini coefficient of total health expenses was 0.19 and 0.73 separately.The Gini coefficient range of health service was 0.10-0.24 and 0.55-0.76 separately.(2)The overall efficiency of Shandong,Henan,Hunan,Guangdong,Sichuan,Guizhou,and Tibet was 1.12 regions' the node 1 efficiency value was 1.Shanghai,Liaoning,Beijing the node 1efficiency value is less than 0.6.17 regions' the Node 2 efficiency value was 1.Shanxi,Inner Mongolia,Jilin the Node 2 efficiency value was less than 0.6.(3)Weight of the score matrix in fair-efficiency equilibrium model: the number of medical institutions 0.20,medical institutions beds 0.40,health personnel 0.40,the total efficiency 0.44,technical efficiency 0.40 and scale efficiency 0.16.Conclusions1.The general level of health resources allocation has improved,but the relationship between need and supply was not balance.(1)The health system covering urban and rural has been built.(2)The general level of health resources allocation has improved,but the structure and composition still not reasonable.(3)The demand of health resource has been increased while shorting of the allocation of health resource.2.The health service system general improved while the contradiction of need,demand and supply serious.(1)The health service system general improved,capacity of health service supply has been strengthened.(2)Health service need increased as well as diseases pattern continue change.(3)Outpatient service demand decreased and the level of utilization has been improved.(4)Inpatient utilization increased and the efficiency of supply has been improved.3.The equity and efficiency of health resources allocation and health service supply need be improved,the fair-efficiency equilibrium model comply with Chinese characteristics.(1)The allocation of health resources and service is more equity according to population than geographical.(2)7 provinces health resource allocation and health services supply overall efficient,and others were inefficient.(3)Establishment of fair-efficiency equilibrium model has necessity.The result of prove feasibility.Policy Suggestions1.In the terms of health resource allocation,optimize the allocation structure,promote the human resource exchange,increase the efficiency of utilization,improve financing policies,standardized the transfer payment,and eliminate hospital expenses with medicine revenue.2.In the terms of health service supply,strengthen the bidirectional function between allocation and supply,shorten the length of hospital stay,pay attention to the diseases pattern changes,improve the aging care,electronic clinical pathway,mining medical information.3.In the terms of the balance between equity and efficiency,avoid excessive concentration,give play to the role of leverage,integration of health data,introducing the "mobile plus",establish the legal system,and deepen the system reform. |
PDF Full Text Request