我国乡村医生和卫生员资源配置的时空差异及其影响因素  

The Spatiotemporal Differences and Influencing Factors of Rural Doctors and Health Workers Resource Allocation in China

作　　者：罗姚 谈在祥 杨晶 LUO Yao(The Xuzhou Clinical College of Xuzhou Medical University,Xuzhou,Jiangsu,221006,China)

机构地区：[1]徐州医科大学徐州临床学院,江苏徐州221006 [2]徐州医科大学管理学院,江苏徐州221004 [3]徐州医科大学附属医院,江苏徐州221006

出　　处：《医学与社会》2024年第9期13-19,26,共8页Medicine and Society

基　　金：国家社会科学基金资助项目,编号为19FJYB014;2022年徐州市科技计划项目--重点项目,编号为KC22157。

摘　　要：目的:分析2009-2021年我国乡村医生和卫生员资源配置的时空差异,为优化乡村卫生人力资源配置提供参考。方法:收集2009-2021年我国31个省份乡村医生和卫生员的面板数据,构建空间杜宾模型,分析我国乡村医生和卫生员省际间流动的主要影响因素和空间溢出效应。结果:2009-2021年我国乡村医生和卫生员总量下降趋势明显。乡村医生和卫生员配置在省级层面具有一定的空间集聚特征,存在显著的空间溢出效应。空间集聚变动不大,存在个别省份轻微变动。“高-高”集聚态势从最初的中部地区覆盖到了西部地区的云南、贵州和广西,“低-低”集聚现象依旧主要集中在东部地区和西北地区。农村养老机构数(直接效应0.001,间接效应-0.002)、乡镇文化站数(直接效应0.014,间接效应0.013)、乡村人口占总人口比重(间接效应-0.415)、农村居民人均可支配收入(间接效应-5.092)、村卫生室数(间接效应0.001)是影响乡村医生和卫生员省际间流动的主要因素。结论:新医改以来,我国乡村医生和卫生员集聚效应逐渐减弱,资源分布差异仍然存在。因此,在优化基层卫生资源布局时,应当重点关注卫生资源配置过程的整体效应,继续加大对基层医疗卫生网络建设的支持力度、探索创新卫生服务模式,以更好地满足乡村居民的医疗需求。Objective:To analyze the spatiotemporal disparities in the allocation of rural doctors and health workers in China from 2009 to 2021,so as to provide insights for optimizing human resources in rural healthcare.Methods:Panel data on rural doctors and health workers from 31 provinces in China spanning the years 2009 to 2021 were collected.A spatial Durbin model was employed to analyze the main influencing factors and spatial spillover effects of the interprovincial migration of rural doctors and health workers in China.Results:From 2009 to 2021,there was a noticeable downward trend in the total number of rural doctors and health workers in China.At the provincial level,the allocation of these professionals exhibited certain spatial agglomeration characteristics,accompanied by significant spatial spillover effects.The spatial clustering showed minor variations,with only a few provinces experiencing slight fluctuations.The'high-high'clustering pattern initially found in the central regions has expanded to cover the western areas of Yunnan,Guizhou,and Guangxi.Conversely,the'low-low'clustering phenomenon remains predominantly concentrated in the eastern and northwest regions.Key factors influencing the interprovincial migration of rural doctors and health workers include the number of rural elderly care institutions(direct effect:0.001,indirect effect:-0.002),the number of township cultural stations(direct effect:0.014,indirect effect:0.013),the proportion of the rural population to the total population(indirect effect:-0.415),rural residents'per capita disposable income(indirect effect:-5.092),and the number of village health clinics(indirect effect:0.001).Conclusion:Since the initiation of the new healthcare reform in China,the agglomeration effect of rural doctors and health workers has gradually diminished,and disparities in health resource distribution persist.Therefore,when optimizing the layout of primary health resources,it is crucial to focus on the overall effects of the health resource allocation process.Con

关 键 词：乡村医生 卫生员 资源配置 时空差异 影响因素 

分 类 号：R-05[医药卫生] R192.3