| BackgroundAs one of the management items of the Health Administration Department under the State Council, the Large-scale Radiation Medical Instruments (LRMIs) use radioisotopes and radiation devices for clinical diagnosis, treatment and health check-up. It is under the large-scale medical instruments management (it can be divided into categories A, B), with B administered by the provincial health administration departments. Based on the principle of ionizing radiation, the various kinds of newly-developed high-tech radiation medical instruments have been rapidly put into clinical application and greatly improved the accuracy of the diagnosis and treatment effect, with the advantages of being fast and accurate, static and dynamic, having clear images and precise effects, as well as small damage and suffering. LRMIs have played an increasingly important role in the medical and health services. The increase in their number, on the one hand, shows the level of China's import and use of high-level medical technology and the services capacity of medical institutions. On the other hand, the cost of medical and health services has risen too fast as a result of a huge investment. Because LRMIs could generate considerable economic benefits, large and medium-sized medical institutions, in the regulation of the market mechanism and driven by huge profits, purchased them without planning or feasibility analysis. In many areas the dramatic increase in the number results in many instruments lying idle. It is a waste of resources. At the same time, LRMIs are mainly distributed in large and medium-sized medical institutions of the large and medium-sized cities, leading to inequalities in the utilization of health services and resources, causing great public dissatisfaction and aggravating the doctor-patient conflicts. Premier Wen Jiabao pointed out in the Government Report that the reform will put social equity on top. It is more important to eliminate or reduce the fairness gap of public health than that of the income. It is, therefore, necessary for rational allocation and effective use of LRMIs and enhancement of the Government's macro-control to improve the fairness, control the excessive growth of health costs, maintain the rights and interests of patients and develop public health. The allocation of LRMIs is related to health care and security reform, social equity in public health services, and social harmony. With the experience of large-scale medical equipment management both at home and abroad and step-by-step implementation of the regulations, China has begun the application of more scientific management concept to control and regulate LRMIs, including large-scale medical equipment planning and management, forming a framework for macro-management system and achieving a certain degree of experience and effectiveness.Research objectiveThrough the investigation on the existing Category B Large-scale Radiation Medical Instruments (LRMIs) in Heilongjiang Province, this paper aims to find out the amount of LRMIs, its geographical distribution and status of the application in order to have a preliminary analysis on the fairness, make evaluation on the scientific status quo, find the problems and give corresponding countermeasures and suggestions on the planning and management of the allocation of LRMIs.Data and methodsThrough the Statistical Yearbook and reports, we have access to the area size, population of the 13 cities, the number and geographical distribution of four Category B LRMIs in the 13 cities, as well as the yearly total usage (per person) of the four Category B LRMIs, the positive rate, the positive rate standard and LRMIs'yearly service standards. Based on Lorenz curve and the principles of Gini coefficient, we calculate the Gini coefficient of Category B LRMIs in Heilongjiang Province and draw Lorenz curve map in order to analyze the fairness of the allocation. At the same time, the paper conducts a preliminary analysis on the existing allocation, with the application of Performance Targets Method into calculating the amount of allocation, which is compared with the actual number of allocation. ResultsThe Gini coefficient of the allocation per capita of Category B LRMIs in Heilongjiang Province is 0.179, with pretty fairness, at the absolute average level. The Gini coefficient of allocation per capita of CT is 0.165, at the absolute average level, which means that CT's fairness of allocation is better than other large-scale radiation medical instruments. Next is followed by DSA, LA, SPECT above 800mA, with the Gini coefficient in the range of 0.3 to 0.4. The fairness is of a reasonable level. Of which, the Gini coefficient of SPECT is 0.381, close to the internationally recognized warning line of 0.4. The Gini coefficient of the allocation in total area is 0.410, shows that there is a larger gap on the allocation per unit area, the fairness being poor. The Gini coefficient of CT allocation in area is 0.383, at a more reasonable level. The fairness of allocation in area is better than the other large-scale radiation medical instruments. Next is followed by DSA, LA, SPECT above 800mA, the Gini coefficient of allocation in area exceeding the internationally recognized warning Line of 0.4, with the fairness in a disparity level. The Gini coefficient of SPECT's allocation in area is 0.656, showing that the equipment allocation is obviously unfair.Based on Performance Targets Method, the calculated total amount of CT is 257, while the existing one is 288; the calculated amount of DSA over 800mA is 38, while the existing amount is 46; the calculated amount of SPECT is 15, while the existing amount is 12; the calculated amount of LA is 32, while the existing amount is 27. In cities with calculation conditions, the existing amounts of CT and DSA over 800mA have exceeded the calculated amount, while in underdeveloped regions and areas it is vice versa. But the gap is not very clear. The existing LA and SPECT are lower than the calculated amount, with part of the cities (most of them are underdeveloped regions) not having calculation conditions. There is a considerable gap in cities of different levels of economy. Thus, priority should be given with regard to the actual situation in future allocation planning.ConclusionThe allocation per capita of Category B LRMIs in Heilongjiang Province has reached a Reasonable fairness, but that of the allocation in area is relatively poor. The existing amounts of CT and DSA over 800mA have exceeded the calculated amount, while those of SPECT and LA are lower than the calculated ones. The allocation amount of Category B LRMIs in Heilongjiang Province is in the middle position among developed countries and at the intermediate level at home, lagging behind the overall level of economically developed provinces. There still remain some problems in allocation and management. Rational distribution of Category B LRMIs, improvement in allocation fairness, bridging the gap in medical and health services among different regions and groups are of important practical significance to promote the cause of health reform and improve the level of medical and health services, to achieve the target of All Enjoy the Results of the reform, and to establish a harmonious society. The results of this study will provide reference for decision-making by health administrative departments on future allocation of health resources.Innovation and SignificanceThis study found out the actual number and distribution of Category B LRMIs in Heilongjiang Province and provided detailed and accurate data for the allocation planning and supervision. It is the first time that people analyzed the fairness of allocation and compared the existing amounts of equipments with the estimated amount. The research results will offer evidence for the decision-making of Health Administration Departments in line with the actual situation in our province. With the strategies and suggestions, we aim to develop management policies and regulations for LRMIs'allocation and planning and to achieve a reasonable distribution of health resources. |
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