中国全科医生资源配置公平性现状研究  

Fairness in the Distribution of General Practitioner Resources in Chinese Mainland

作　　者：寇儒欣 梅康妮 秘玉清 陈彤 邓神根 邢家润 王芊芊 王梦雪 李伟[1] KOU Ruxin;MEI Kangni;BI Yuqing;CHEN Tong;DENG Shengen;XING Jiarun;WANG Qianqian;WANG Mengxue;LI Wei(School of Public Health,Weifang Medical University,Weifang 261021,China;School of Management,Weifang Medical University,Weifang 261021,China)

机构地区：[1]潍坊医学院公共卫生学院,山东省潍坊市261021 [2]潍坊医学院管理学院,山东省潍坊市261021

出　　处：《中国全科医学》2023年第19期2339-2345,2354,共8页Chinese General Practice

基　　金：国家自然科学基金资助项目(71774119);全国统计科学研究项目(2021LY033);中国学位与研究生教育学会研究课题(2020MSA247);山东省人文社会科学课题(2022-ZXJK-18)。

摘　　要：背景 近年来国家高度重视全科医生队伍建设和基层卫生服务体系建设工作。围绕创新全科医生培养与使用激励机制和健全全科医生培养体系,政府出台了许多政策,从多个方面提出了多项重大改革举措。目的 分析和评价中国全科医生资源配置公平性,为科学、公平分配全科医生资源提供理论支持。方法 于2022年6月,以2017—2021年《中国卫生和计划生育统计年鉴》《中国卫生健康统计年鉴》和《中国统计年鉴》作为数据源,提取2016—2020年全国、各省份、各地区(东、中、西部地区)的全科医生数、注册为全科医学专业的人数、取得全科医生培训合格证的人数、每万人口全科医生数、执业(助理)医师数,以及2016—2020年国内生产总值、地区生产总值、各省份年末总人口数据;从中国政府网的国情栏目中提取各省份土地总面积数据。使用洛伦兹曲线与基尼系数分析中国全科医生资源配置公平性,使用泰尔指数分析我国东、中、西部地区全科医生资源配置差异性。结果 中国全科医生数由2016年的209 083人增长到2020年的408 820人,2020年中国全科医生数较2016年增长了95.53%。2020年,在执业(助理)医师中,全科医生占比已达10.01%(408 820/4 085 689),每万人口全科医生数为2.90人。2016—2020年中国全科医生资源配置在人口维度上的基尼系数分别为0.235、0.231、0.225、0.177、0.157,在经济维度上的基尼系数分别为0.178、0.170、0.161、0.147、0.136,在地理维度上的基尼系数分别为0.722、0.726、0.729、0.714、0.707;相较于地理维度的洛伦兹曲线弯曲程度,人口维度与经济维度的洛伦兹曲线弯曲程度更小。人口维度的泰尔指数由2016年的0.046降至2020年的0.020,经济维度的泰尔指数由2016年的0.022降至2020年的0.013,地理维度的泰尔指数由2016年的0.482降至2020年的0.428。结论 近5年来,中国全科医生数量快速上升Background In recent years,China has attached great importance to strengthening the development of general practitioner(GP)workforce and primary care service system.To innovate the incentive mechanism for GP training and employment and improve the training system for GPs,the government has also promulgated a series of policies and put forward major reform measures involving many aspects.Objective To analyze and evaluate the fairness of distribution of general practitioner(GP)resources in China,and to provide theoretical support for scientific and equitable allocation of GP resources.Methods Data were sourced from five volumes of China Health and Family Planning Statistical Yearbook(2017—2021),China Health Statistical Yearbook(2017—2021),and China Statistical Yearbook(2017—2021)in June 2022,including the number of GPs,the number of people registered as general medicine professionals,the number of people who obtained the General Practitioner Certificate after training,the number of GPs per 10 000 population,and the number of practicing(assistant)physicians in China,in each geographical division(eastern,central or western),and in each regionin,and the annual gross domestic product(GDP),gross regional product(GRP),and the year-end total population data of each region during 2016and 2020.Additionally,the total land area of each region was extracted from the China ABC column on the website www.gov.cn.The Lorenz curve and the Gini coefficient were used to analyze the fairness in the distribution of GP resources.The Theil index was used to analyze differences in the distribution of GP resources in eastern,central and western China.Results The number of GPs in China increased from 209 083 in 2016 to 408 820 in 2020,showing a growth rate 95.53%.In 2020,the proportion of GPs among all practicing(assistant)physicians reached 10.01%(408 820/4 085 689),and the number of GPs per 10 000population was 2.90.The Gini coefficients measuring demographic,economic,and geographical distribution inequalities of GP resources were 0.

关 键 词：全科医生 资源配置 洛伦兹曲线 基尼系数 泰尔指数 健康公平 

分 类 号：R192.3[医药卫生—卫生事业管理]