| Objectives Based on the analysis of the status of health resources allocation in Gansu Province,this paper sheds light on the basic situation,operational effects and main problems of the hierarchical medical treatment system in Gansu Province,and proposes possible policies and suggestions for improving the hierarchical medical treatment system in Gansu Province.Hopefully it will provide a reference for a more reasonable allocation of regional health resources and promote the construction of medical service system.Methods The centralized index method,Taylor index method and data envelopment analysis method were adopted in analyzing the fairness and efficiency of the health resources allocation in Gansu Province;the single factor analysis method was adopted in analyzing the patients distribution,disease distribution,cost and compensation;the recursive system model analysis method was taken in analyzing the influencing factors of hospitalization cost of circulatory system diseases.Results(1)Fairness of health resources allocation: from 2015 to 2017,the total amount of health resources in Gansu Province had seen a steady increase,but the health resources allocation was remarkably unfair in different regions,with regions of higher economic development level enjoying a favorable proportion of the health resources.In 2017,the fairness level of health resources allocation in four regions of Gansu Province divided according to their geographical gradients and economic levels was ranked in a declining order as follows: the marginal zone of the Qinghai-Tibet Plateau(Linxia Hui Autonomous Prefecture,Gannan Tibetan Autonomous Prefecture),Hexi District(Jiuquan City,Jiayuguan City,Jinchang City,Zhangye City,Wuwei City),Longdong District(Tianshui City,Weinan City,Pingliang City,Qingyang City),Longzhong District(Lanzhou City,Dingxi City,Baiyin City);There was a remarkable unfairness in health resources distribution in these four regions,in which the distribution of health institutions was the most unfair index,while the distribution of hospital bed numbers was the least unfair index.(2)Effectiveness of health resources allocation: the efficiency of health resources allocation in Gansu Province was high in 2017,with 91% of Gansu’s health resources being fully utilized,whereas the efficiency of health resources allocation in different cities and prefectures varied greatly.Research showed that in 2017,the health resources of Jiayuguan City,Jinchang City,Dingxi City,Longnan City and Linxia Hui Autonomous Prefecture were relatively fully utilized;though Lanzhou City,Tianshui City and Wuwei City had a larger scale of health resources than that of other cities and prefectures,the increase rate of medical service efficiency was lower than that of the health resources input,indicating an inefficient utilization of the health resources in these cities;besides,the health resources in Baiyin City,Zhangye City,Pingliang City,Jiuquan City,Qingyang City and Gannan Tibetan Autonomous Prefecture were not fully utilized,and the reason might be attributed to the inefficient health resources allocation,low bed utilization rate and inadequate hospitalized indicators.(3)The overall operation of hierarchical medical treatment: the coverage of the hierarchical medical treatment system in Gansu Province increased significantly in2017,with more than 80% of the total number of patients accepting the hierarchical medical treatment.In terms of regional distribution,patients accepting the hierarchical medical treatment were mainly from Longdong District and Longzhong District;the visits rate in primary medical institutions increased,especially in county-level medical institutions which had the most visits.From the perspective of population distribution,women accepting the hierarchical medical treatment were more than men,and patients aged 60 to 69 were the main group.From the angle of disease distribution,circulatory diseases,respiratory diseases,digestive diseases,musculoskeletal and connective tissue diseases,and pregnancy,childbirth and puerperal diseases were major diseases that threatened the health of residents.The actual compensation ratio of hospitalization expenses for hierarchical medical treatment saw an annual increase,and the proportion of medicine expenses to hospitalization expenses decreased.Gender,age,hierarchical medical treatment implementation year,hospital level of first diagnosis,referral status,and whether being “ordinary farmers,households enjoying the five guarantees or poor households” were the main influencing factors for hospitalization expenses of diseases(circulatory diseases)with most visits covered by hierarchical medical treatment.Conclusions The total amount of health resources in Gansu Province has increased steadily,whereas the allocation of health resources in various cities and states is unfair and the utilizing efficiency thereof remains low,some being idled or wasted;the hierarchical medical system runs well,with an increasing number of people covered annually.Nevertheless,there are also some problems as follows: the increase ratio of per visit expense is greater than the compensation ratio;the drug expense is high;the service capacity of the county-level medical institutions remains to be improved,and so does the hierarchical medical treatment operation mechanism for chronic diseases. |
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