Study On The Efficiency And Fairness Of Health Resource Allocation In Basic Medical And Health Institutions In Jilin Province

Objective:Based on the data of health resource allocation of primary medical and health institutions in Jilin Province in 2018,Using different methods to analyze the basic situation,efficiency and fairness of health resource allocation,Find out the problems existing in the allocation of health resources in the basic medical and health institutions of Jilin Province,and put forward the corresponding countermeasures and suggestions,In order to improve the allocation of health resources in basic medical and health institutions in Jilin Province and improve the efficiency and fairness of health resources allocation.Methods:Filtering and sorting the data of "National Health Statistics network direct reporting system",reported by Jilin provincial health institutions,Get the data used in the research.The basic situation of health resource allocation of basic medical and health institutions in Jilin Province in 2018 was obtained by using descriptive statistical method,and compared with relevant national indicators to find out the shortage of health resource allocation;According to data envelopment analysis(DEA),DEAP 2.1 software was used to analyze the efficiency of health resource allocation in primary medical and health institutions,According to the BCC model in DEA,the ideal values of health resources input and health service output of basic medical and health institutions in Jilin Province are obtained;Introduce Gini coefficient in economic method,use Lorenz curve to calculate Gini coefficient,and analyze the equity of health resource allocation of primary medical and health institutions in Jilin Province in 2018,We get the fairness of different types of health resources in terms of population allocation and geographical area allocation.Results:1.Basic situation of health resources allocation of basic medical and health institutions in Jilin Province: primary medical and health institutions in Jilin Provinceshowed obvious regional differences in health human resources,health and material resources and health and financial resources.In terms of health human resources,the total number of health personnel in primary medical and health institutions in Jilin Province in 2018 was 75838,of which 21653 and 13166 were in Changchun and Jilin,respectively.The number of health personnel in primary medical and health institutions in these two cities accounted for 45.9 percent of the total in Jilin Province,while the number of primary medical personnel in Liaoyuan and Baishan cities in medical and health institutions is only 3039 and 3300,the gap is obvious.On health and material resources,the number of primary medical and health institutions in Changchun and Jilin City and the number of beds in primary medical and health institutions are in the leading position,Liaoyuan City and Baishan City are at the bottom of these two health resources,In different types of basic medical and health institutions,there are differences in the average number of beds between community health service centers and township health centers,and Changchun City and Yanbian Korean Autonomous Prefecture are at the forefront of the number of equipment over10,000 yuan and the total value of equipment over 10,000 yuan,while Liaoyuan City and Baishan City are still at the bottom,In terms of different types of basic medical and health institutions,there is no difference in the average number of equipment above 10000 yuan and the total value of equipment above 10000 yuan between community health service centers and township health centers.In terms of health financial resources,Changchun,Jilin and Siping cities have more financial investment in primary medical and health institutions and less in Liaoyuan and Baishan cities,The financial subsidy income of the primary medical and health institutions in nine cities and states of Jilin Province accounted for about 51.9% of the total income of the primary medical and health institutions on average.In terms of fixed assets per bed,in addition to Liaoyuan City,Baishan City and Songyuan City,the basic medical and health institutions in other cities and states have basically the same level of fixed assets per bed,In terms of different types of basic medical and health institutions,there is no difference between community health service centers and township hospitals in fixed assets per bed.In the 《 Outline of the National Medical and Health Service System Plan(2015-2020)》(hereinafter referred to as the《Outline》),it is mentioned that the ratio of doctor and nurse in primary medical and health institutions in China in 2020 is1:1.25,and the number of health personnel per thousand population is 3.5.In terms of the ratio of doctor and nurse,the overall medical care ratio of primary medical and health institutions in Jilin Province is 1:0.6,and the nine cities and states are not up to the standard,and the gap is wide.The best ratio of doctor and nurse of primary medical and health institutions in nine cities and states is Yanbian Korean Autonomous Prefecture,with a ratio of doctor and nurse of 1:0.7,the biggest gap was in Baicheng,with a ratio of doctor and nurse of only 1:0.4;from the different types of primary medical and health institutions,the community health service center(station)is significantly better than the township health center and village health center,the ratio of doctor and nurse of village health center is the largest difference.In terms of the number of health personnel,the number of health personnel per 1,000 people in Jilin Province is 2.9,and all the cities and states have not met the standard in the Outline.Among them,the number of primary medical and health institutions per1,000 people in Yanbian Korean Autonomous Prefecture is the highest,reaching 3.35,and the number of primary medical and health institutions per 1,000 people in Liaoyuan City is the least,only 2.59.In the 《 Outline 》,it is also mentioned that the number of beds per 1,000 population in primary medical and health institutions should reach 1.2 in 2020,in2018 in Jilin Province the number is 0.83,and only Liaoyuan City and Tonghua City in nine cities in Jilin Province have reached the standard,the number is 1.26 and 1.46,Changchun is the least city with 0.57 beds per 1,000 people in primary medical and health institutions.2.In 2018,the health resource allocation efficiency of primary medical and health institutions in Jilin Province has reached DEA effectiveness in four cities,namely Changchun City,Liaoyuan City,Tonghua City and Songyuan City.The health resources input and output of primary medical and health institutions in these four cities need not be changed.In the cities that did not reach DEA effective,the pure technical efficiency of Jilin City and Baishan City is 1,and the input of health resources of primary medical and health institutions in these two cities does not needto be changed,but only to adjust the scale of primary medical and health institutions.The comprehensive efficiency and pure technical efficiency of the health resource allocation efficiency of the primary medical and health institutions in Siping City,Baicheng City and Yanbian Korean Autonomous Prefecture are not 1,so it is necessary to adjust the input and output of the primary medical and health institutions.Non-DEA effective cities need to adjust the size of primary medical and health institutions.Among them,Jilin City and Yanbian Korean Autonomous Prefecture need to reduce the size of primary medical and health institutions,and Siping City,Baishan City and Baicheng City need to increase the size of Primary Health Care Institutions.3.The allocation of health resources in primary medical and health institutions in Jilin Province is fair in terms of population allocation and geographical area allocation.The health resources selected by calculating Gini coefficient include the number of primary medical and health institutions,the number of health personnel in primary medical and health institutions and the number of beds in primary medical and health institutions.In 2018,the number of health resources in primary medical and health institutions in Jilin Province reached a high degree of fairness in terms of population allocation,among which,the number of primary health institutions in the population allocation of Gini The coefficient is 0.124,the Gini coefficient of the number of health personnel in primary health institutions in the population is 0.038,and the Gini coefficient of the number of beds in primary health institutions in the population is0.174.In terms of geographical distribution,the number of primary health institutions and the number of health personnel in primary health institutions have reached an equitable allocation in terms of geographical area,the Gini coefficient is 0.287 and0.2 respectively,and the number of beds in primary health institutions is highly equitable in terms of geographical area,with a Gini coefficient of 0.187.Conclusions:1.There are great differences in the allocation of health resources between different regions;the allocation of health personnel and beds in grass-roots medical and health institutions is insufficient.2.The efficiency of health resource allocation needs to be improved.Only four cities and prefectures have reached the DEA effective state.The cities and prefecturesthat are not DEA effective state,the input and output of health resources and the scale of grass-roots medical and health institutions are far from the ideal state.3.The fairness of health resources allocation is good,and the fairness of population and geographical area allocation has reached a relatively fair state.Based on the research results,the following suggestions are proposed:Jilin Province needs to increase the input of resources to primary medical and health institutions,introduce high-quality professionals,integrate the efficiency and fairness of resource allocation into performance appraisal,strengthen the overall role of the government,and realize the optimal allocation of health resources.