Article(id=1241022943833158474, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202409456, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1727193600000, receivedDateStr=2024-09-25, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812526901, onlineDateStr=2026-03-18, pubDate=1742832000000, pubDateStr=2025-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812526901, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812526901, creator=13701087609, updateTime=1773812526901, updator=13701087609, issue=Issue{id=1241022939957621542, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773812525976, creator=13701087609, updateTime=1773815469296, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241035285174219432, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241035285174219433, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1092, endPage=1098, ext={EN=ArticleExt(id=1241022944101593945, articleId=1241022943833158474, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Spatio-temporal evolution analysis of the coordinated development of medical resource allocation and service utilization, Jiangsu, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To study the coordinated development of healthcare resource allocation and service utilization in Jiangsu Province.

Methods

Using various statistical methods, its spatio-temporal evolution characteristics and driving factors were profiled.

Results

The degree of coupling coordination showed an overall upward trend during 2015-2021, which declined in 2020 but quickly rebounded in the following year; the province’s entropy-weighted TOPSIS composite index was basically below 0.5, with Nanjing, Wuxi, and Suzhou’s composite scores significantly higher than those of other cities, and the service utilization index as a whole was significantly higher than that of the resource allocation index; Lianyungang, in terms of the value of the degree of relative development, was much higher than that of the province’s other cities, presenting an extremely significant resource over-advancement type; the influence factors selected in this paper can be better realistic and statistically significant in terms of selection objectives and significance.

Conclusion

The coordinated development of medical resource allocation and service utilization of health institutions in prefecture-level cities in Jiangsu Province has obvious geographical boundaries of spatial and temporal changes,2015-2021. In addition, although the better economically developed areas performs better than the relatively less economically developed areas in terms of healthcare resource allocation and service utilization but shows a regression in the composite scores, healthcare resource allocation may be an entry point for the balanced development of the province. The study also find that factors such as population distribution and level of economic development have a significant impact on the degree of coordination over the seven years.

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目的

针对江苏省医疗资源配置和服务利用协调发展进行研究。

方法

运用多种统计学方法,对其时空演化特征及驱动因子进行了剖析。

结果

耦合协调度在2015—2021年间,总体呈上升趋势,虽在2020年出现下降但在次年迅速回升;全省熵权TOPSIS综合指数基本在0.5以下,南京、无锡、苏州综合得分明显高于其他城市,服务利用指数整体显著高于资源配置指数;连云港在相对发展度的数值上,远高于省内其他市,呈现出极为显著的资源超前型;本文所选取的影响因子在选取目标和显著性上均能较好的现实意义与统计学意义。

结论

在2015—2021年期间,江苏省各地级市卫生机构医疗资源配置与服务利用的协调发展存在着明显的时空变化地理界限。此外,经济发展较好的地区虽在医疗资源配置和服务利用方面表现优于经济相对欠发达的地区但表现出综合得分倒退的态势,医疗资源配置或可成为全省均衡发展的切入点。研究还发现,人口分布和经济发展水平等因素对这7年的协调程度产生了显著影响。

, correspAuthors=null, authorNote=null, correspAuthorsNote=
孙玲,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=tF4UVu61f7DLM2iKbObm3A==, magXml=cbxvSGbjpQ2JTIyRs71puw==, pdfUrl=null, pdf=zUBRv/VHshudCNK602Dp9Q==, pdfFileSize=924222, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=jcNE3QD5il0D8IlIAbMYbA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=us29YoMjrIR+cMm9TdP/kA==, mapNumber=null, authorCompany=null, fund=null, authors=

邹陆曦(1982—),男,博士,副教授,高级工程师,研究方向:智慧医疗与数字健康研究

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邹陆曦(1982—),男,博士,副教授,高级工程师,研究方向:智慧医疗与数字健康研究

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邹陆曦(1982—),男,博士,副教授,高级工程师,研究方向:智慧医疗与数字健康研究

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(In Chinese), articleTitle=Analysis on the allocation Equity and improvement path of health care institutions in China, refAbstract=null)], funds=[Fund(id=1241022953383588238, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, awardId=2024SJZD062, language=CN, fundingSource=江苏高校哲学社会科学研究重大项目(2024SJZD062), fundOrder=null, country=null), Fund(id=1241022953496834459, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, awardId=202410313111Y, language=CN, fundingSource=大学生创新创业训练计划项目(202410313111Y), fundOrder=null, country=null), Fund(id=1241022953593303458, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, awardId=ZD2022044, language=CN, fundingSource=江苏省卫生健康委医学科研重点项目(ZD2022044), fundOrder=null, country=null), Fund(id=1241022953727521200, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, awardId=Y12023008, language=CN, fundingSource=江苏省卫计委预防医学科研课题(Y12023008), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241022947314430944, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, xref=1., ext=[AuthorCompanyExt(id=1241022947327013857, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, companyId=1241022947314430944, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Xuzhou Medical University, Xuzhou, Jiangsu 221000, China), AuthorCompanyExt(id=1241022947347985380, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, companyId=1241022947314430944, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.徐州医科大学,江苏 徐州 221000)]), AuthorCompany(id=1241022947507368943, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, xref=2., ext=[AuthorCompanyExt(id=1241022947515757553, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, companyId=1241022947507368943, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.徐州市中心医院)])], figs=[ArticleFig(id=1241022949340278941, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, language=EN, label=Fig.1, caption=System eigenvalues, figureFileSmall=I7soUoEGltPJ5BhpttYIYQ==, figureFileBig=jcNE3QD5il0D8IlIAbMYbA==, tableContent=null), ArticleFig(id=1241022949453525160, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, language=CN, label=图1, caption=系统特征值, figureFileSmall=I7soUoEGltPJ5BhpttYIYQ==, figureFileBig=jcNE3QD5il0D8IlIAbMYbA==, tableContent=null), ArticleFig(id=1241022951118663881, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, language=EN, label=Fig.2, caption=System relative development degree results, figureFileSmall=gAz5CHr2t6UdFheXRvPTng==, figureFileBig=hPyt4Yy6kE70hrxmLhVjKg==, tableContent=null), ArticleFig(id=1241022951215132879, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, language=CN, label=图2, caption=系统相对发展度结果, figureFileSmall=gAz5CHr2t6UdFheXRvPTng==, figureFileBig=hPyt4Yy6kE70hrxmLhVjKg==, tableContent=null), ArticleFig(id=1241022951340962009, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, language=EN, label=Fig.3, caption=Comparison of service utilization and resource allocation indices by municipality, figureFileSmall=2YU3iNKx+V89mKvvRwlNIw==, figureFileBig=B6MDyKuw2hSILULBpXYtUA==, tableContent=null), ArticleFig(id=1241022951638757604, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, language=CN, label=图3, caption=各市服务利用与资源配置指数对比图

注:图3中同一地区,上为资源配置指数,下为服务利用指数。

, figureFileSmall=2YU3iNKx+V89mKvvRwlNIw==, figureFileBig=B6MDyKuw2hSILULBpXYtUA==, tableContent=null), ArticleFig(id=1241022951777169646, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022943833158474, language=EN, label=Table 1, caption=

Evaluation index system of medical resource allocation and service utilisation in Jiangsu Province

, figureFileSmall=null, figureFileBig=null, tableContent=
系统层目标层指标层方向
资源配置机构卫生机构密度指数+
床位床位密度指数+
人员卫技人员密度指数+
费用总费用支出/万元+
人均费用支出/万元+
服务利用门诊人均诊疗人次+
医生人均每日担负诊疗人次+
健康检查率/%+
住院病床使用率/%+
出院者平均住院日/天-
住院率/%+
医生人均每日担负住院床日/天+
人均住院手术次数/次+
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江苏省医疗资源配置与服务利用评价指标体系

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系统层目标层指标层方向
资源配置机构卫生机构密度指数+
床位床位密度指数+
人员卫技人员密度指数+
费用总费用支出/万元+
人均费用支出/万元+
服务利用门诊人均诊疗人次+
医生人均每日担负诊疗人次+
健康检查率/%+
住院病床使用率/%+
出院者平均住院日/天-
住院率/%+
医生人均每日担负住院床日/天+
人均住院手术次数/次+
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Criteria for classifying the degree of coupling coordination

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耦合协调度D值区间耦合协调程度
(0.0,0.1)极度失调
(0.1,0.2)严重失调
(0.2,0.3)中度失调
(0.3,0.4)轻度失调
(0.4,0.5)濒临失调
(0.5,0.6)勉强协调
(0.6,0.7)初级协调
(0.7,0.8)中级协调
(0.8,0.9)良好协调
(0.9,1.0)优质协调
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耦合协调度等级划分标准

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耦合协调度D值区间耦合协调程度
(0.0,0.1)极度失调
(0.1,0.2)严重失调
(0.2,0.3)中度失调
(0.3,0.4)轻度失调
(0.4,0.5)濒临失调
(0.5,0.6)勉强协调
(0.6,0.7)初级协调
(0.7,0.8)中级协调
(0.8,0.9)良好协调
(0.9,1.0)优质协调
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Composite score index of entropy weighted TOPSIS method for each city

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地区2015201620172018201920202021
南京0.7270.6900.6760.7350.7580.7470.730
无锡0.6280.6160.6040.5740.5540.5300.533
常州0.4230.4340.4040.3810.3860.3280.390
苏州0.6510.6520.6290.6160.5940.5450.606
镇江0.3790.3380.3330.3290.3420.2930.272
南通0.3480.3360.3330.3230.3510.3880.393
扬州0.2970.2730.2670.2870.3190.3470.289
泰州0.3270.3220.3320.3440.3480.3840.305
徐州0.5220.5240.4830.4480.4370.4140.444
连云港0.2920.3040.2970.2840.3040.2880.285
淮安0.2800.2880.2900.2690.2520.3050.320
盐城0.2250.2150.2220.2990.2910.3170.251
宿迁0.3890.3010.2920.3260.2930.3390.326
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各市熵权TOPSIS法综合得分指数

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地区2015201620172018201920202021
南京0.7270.6900.6760.7350.7580.7470.730
无锡0.6280.6160.6040.5740.5540.5300.533
常州0.4230.4340.4040.3810.3860.3280.390
苏州0.6510.6520.6290.6160.5940.5450.606
镇江0.3790.3380.3330.3290.3420.2930.272
南通0.3480.3360.3330.3230.3510.3880.393
扬州0.2970.2730.2670.2870.3190.3470.289
泰州0.3270.3220.3320.3440.3480.3840.305
徐州0.5220.5240.4830.4480.4370.4140.444
连云港0.2920.3040.2970.2840.3040.2880.285
淮安0.2800.2880.2900.2690.2520.3050.320
盐城0.2250.2150.2220.2990.2910.3170.251
宿迁0.3890.3010.2920.3260.2930.3390.326
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Evolution of coupled coordination types in Jiangsu Province

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地区城市2015年2016年2017年2018年2019年2020年2021年
苏南南京0.9950.9890.9950.9950.9950.9950.995
无锡0.8510.8770.8740.8050.7630.7430.743
常州0.6120.6670.6410.5870.5710.4880.574
苏州0.8870.9280.9150.8560.8210.7750.850
镇江0.4850.4570.4580.4140.3950.3490.313
苏中南通0.5240.5530.5510.5010.5080.5690.546
扬州0.4390.4390.4230.3900.4020.4290.351
泰州0.4660.5160.5370.5030.4760.5450.328
苏北徐州0.7600.7990.7470.6580.6270.6040.635
连云港0.1880.2160.2110.1920.1930.1830.181
淮安0.3710.4190.3840.3030.2180.3180.308
盐城0.1920.2070.2110.2480.2280.2550.181
宿迁0.5310.4060.3920.3680.3300.3840.385
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江苏省耦合协调类型演进

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地区城市2015年2016年2017年2018年2019年2020年2021年
苏南南京0.9950.9890.9950.9950.9950.9950.995
无锡0.8510.8770.8740.8050.7630.7430.743
常州0.6120.6670.6410.5870.5710.4880.574
苏州0.8870.9280.9150.8560.8210.7750.850
镇江0.4850.4570.4580.4140.3950.3490.313
苏中南通0.5240.5530.5510.5010.5080.5690.546
扬州0.4390.4390.4230.3900.4020.4290.351
泰州0.4660.5160.5370.5030.4760.5450.328
苏北徐州0.7600.7990.7470.6580.6270.6040.635
连云港0.1880.2160.2110.1920.1930.1830.181
淮安0.3710.4190.3840.3030.2180.3180.308
盐城0.1920.2070.2110.2480.2280.2550.181
宿迁0.5310.4060.3920.3680.3300.3840.385
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Relative development of municipalities

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地区城市2015年2016年2017年2018年2019年2020年2021年
南京1.0001.0231.0001.0001.0001.0001.000
无锡1.1261.0091.0271.0571.2131.3071.364
苏南常州0.9550.6590.6860.8090.8011.1800.814
苏州0.8740.7580.7790.8400.8960.8790.691
镇江0.2970.2160.1830.1680.1330.1800.435
南通1.1861.0391.0491.1391.0600.5860.799
苏中扬州0.4430.3680.3800.3470.3750.2520.462
泰州0.9480.7890.6610.6470.8820.5603.360
徐州0.6300.6180.7200.8420.7790.7310.633
连云港12.36321.63419.79713.45314.00211.09710.695
苏北淮安0.3920.2620.1980.2720.5930.1550.215
盐城0.0730.0550.0510.0270.0370.0240.093
宿迁0.5800.2350.2450.1360.3600.1260.321
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各市相对发展度

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地区城市2015年2016年2017年2018年2019年2020年2021年
南京1.0001.0231.0001.0001.0001.0001.000
无锡1.1261.0091.0271.0571.2131.3071.364
苏南常州0.9550.6590.6860.8090.8011.1800.814
苏州0.8740.7580.7790.8400.8960.8790.691
镇江0.2970.2160.1830.1680.1330.1800.435
南通1.1861.0391.0491.1391.0600.5860.799
苏中扬州0.4430.3680.3800.3470.3750.2520.462
泰州0.9480.7890.6610.6470.8820.5603.360
徐州0.6300.6180.7200.8420.7790.7310.633
连云港12.36321.63419.79713.45314.00211.09710.695
苏北淮安0.3920.2620.1980.2720.5930.1550.215
盐城0.0730.0550.0510.0270.0370.0240.093
宿迁0.5800.2350.2450.1360.3600.1260.321
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Influence of factors on the coupled coordination of healthcare resource allocation and service utilization

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年份2015201620172018201920202021
人口密度0.799b0.836b0.870b0.889a0.899a0.833b0.815b
人口城镇化率0.6860.838b0.7130.894a0.903a0.766b0.715
人均GDP0.5120.5630.5860.7110.7020.7480.675
居民人均可支配收入0.6720.7080.7460.7580.771b0.766b0.715
非农产业占比0.864b0.6880.788b0.7110.5920.7020.771b
交通可达性0.3610.4930.3400.2310.1560.1300.231
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各因子对医疗资源配置与服务利用耦合协调度的影响力

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年份2015201620172018201920202021
人口密度0.799b0.836b0.870b0.889a0.899a0.833b0.815b
人口城镇化率0.6860.838b0.7130.894a0.903a0.766b0.715
人均GDP0.5120.5630.5860.7110.7020.7480.675
居民人均可支配收入0.6720.7080.7460.7580.771b0.766b0.715
非农产业占比0.864b0.6880.788b0.7110.5920.7020.771b
交通可达性0.3610.4930.3400.2310.1560.1300.231
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江苏省医疗资源配置与服务利用协调发展的时空演化分析
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邹陆曦 1 , 王龙峰 1 , 孙玲 1, 2
现代预防医学 | 卫生政策与管理 2025,52(6): 1092-1098
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现代预防医学 | 卫生政策与管理 2025, 52(6): 1092-1098
江苏省医疗资源配置与服务利用协调发展的时空演化分析
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邹陆曦1, 王龙峰1, 孙玲1, 2
作者信息
  • 1.徐州医科大学,江苏 徐州 221000
  • 2.徐州市中心医院
  • 邹陆曦(1982—),男,博士,副教授,高级工程师,研究方向:智慧医疗与数字健康研究

通讯作者:

孙玲,E-mail:
Spatio-temporal evolution analysis of the coordinated development of medical resource allocation and service utilization, Jiangsu
Lu-xi ZOU1, Long-feng WANG1, Ling SUN1, 2
Affiliations
  • Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
出版时间: 2025-03-25 doi: 10.20043/j.cnki.MPM.202409456
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目的

针对江苏省医疗资源配置和服务利用协调发展进行研究。

方法

运用多种统计学方法,对其时空演化特征及驱动因子进行了剖析。

结果

耦合协调度在2015—2021年间,总体呈上升趋势,虽在2020年出现下降但在次年迅速回升;全省熵权TOPSIS综合指数基本在0.5以下,南京、无锡、苏州综合得分明显高于其他城市,服务利用指数整体显著高于资源配置指数;连云港在相对发展度的数值上,远高于省内其他市,呈现出极为显著的资源超前型;本文所选取的影响因子在选取目标和显著性上均能较好的现实意义与统计学意义。

结论

在2015—2021年期间,江苏省各地级市卫生机构医疗资源配置与服务利用的协调发展存在着明显的时空变化地理界限。此外,经济发展较好的地区虽在医疗资源配置和服务利用方面表现优于经济相对欠发达的地区但表现出综合得分倒退的态势,医疗资源配置或可成为全省均衡发展的切入点。研究还发现,人口分布和经济发展水平等因素对这7年的协调程度产生了显著影响。

医疗资源配置  /  医疗服务利用  /  耦合协调度  /  影响因子
Objective

To study the coordinated development of healthcare resource allocation and service utilization in Jiangsu Province.

Methods

Using various statistical methods, its spatio-temporal evolution characteristics and driving factors were profiled.

Results

The degree of coupling coordination showed an overall upward trend during 2015-2021, which declined in 2020 but quickly rebounded in the following year; the province’s entropy-weighted TOPSIS composite index was basically below 0.5, with Nanjing, Wuxi, and Suzhou’s composite scores significantly higher than those of other cities, and the service utilization index as a whole was significantly higher than that of the resource allocation index; Lianyungang, in terms of the value of the degree of relative development, was much higher than that of the province’s other cities, presenting an extremely significant resource over-advancement type; the influence factors selected in this paper can be better realistic and statistically significant in terms of selection objectives and significance.

Conclusion

The coordinated development of medical resource allocation and service utilization of health institutions in prefecture-level cities in Jiangsu Province has obvious geographical boundaries of spatial and temporal changes,2015-2021. In addition, although the better economically developed areas performs better than the relatively less economically developed areas in terms of healthcare resource allocation and service utilization but shows a regression in the composite scores, healthcare resource allocation may be an entry point for the balanced development of the province. The study also find that factors such as population distribution and level of economic development have a significant impact on the degree of coordination over the seven years.

Healthcare resource allocation  /  Healthcare service utilization  /  Coupled coordination degree  /  Impact factor
邹陆曦, 王龙峰, 孙玲. 江苏省医疗资源配置与服务利用协调发展的时空演化分析. 现代预防医学, 2025 , 52 (6) : 1092 -1098 . DOI: 10.20043/j.cnki.MPM.202409456
Lu-xi ZOU, Long-feng WANG, Ling SUN. Spatio-temporal evolution analysis of the coordinated development of medical resource allocation and service utilization, Jiangsu[J]. Modern Preventive Medicine, 2025 , 52 (6) : 1092 -1098 . DOI: 10.20043/j.cnki.MPM.202409456
医疗资源是居民获得医疗服务的途径,其配置效率关系到人民的健康和卫生事业的发展。目前,大多数发展中国家都存在资源管理效率低下的问题,如何合理配置卫生资源已逐渐成为世界各国共同的话题。虽然我国卫生资源配置的数量在不断增加,但资源配置效率具有显著地域差异[1],距离全面实现人人享有基本医疗卫生服务的目标还有很长的路要走。
随着分级诊疗制度的建设,结合当下中国老龄化进程明显加快的趋势,需尽快优化医疗资源配置以作准备[2]。江苏作为全国首批省级综合医改试点省份,一直致力于提高居民卫生资源的可及性和公平性。近年来虽有学者致力于研究江苏省卫生资源配置现状和效率[3-4]及公平[5-6]问题,还有一部分学者研究与卫生费用相关的问题[7-9],但少有关于协调发展的研究,因此本文基于分级诊疗改革背景及医疗资源配置和利用的关系,剖析了2015—2021年江苏省各地级市卫生机构资源配置和服务利用的客观水平,耦合协调的发展趋势。
在医疗资源这一层面上,本文为更准确反映地区资源配置的实际情况,引入医疗资源密度指数(Health Resources Density Index, HRDI)来衡量地区资源人口分布和地理分布的综合水平,并构建相对应的资源密度指数[10]同时借鉴卫生费用的研究与建议[11-12],构建如下指标体系(表1)。研究数据来源于2016—2019年江苏卫生计生年鉴,2020—2022年江苏卫生健康年鉴和2016—2022年江苏省统计年鉴。
(1)熵权TOPSIS评价法。熵权法可令评价更客观与科学,因此本文在数据标准化的基础上运用此方法计算各年指标权重,然后运用TOPSIS法计算各指标的综合得分指数,计算公式见文献[13]
(2)耦合协调模型。耦合协调度能用于分析事物的协调发展水平,适用分析本文两个系统的关系并在此基础上计算出相对发展度,将相对发展值划分为(0,0.8]、(0.8,1.2)、[1.2,+∞),分别为资源滞后超前型、同步发展型和资源超前型,计算公式见文献[14]表2为协调度划分等级。
(3)地理探测器。地理探测器用于探测空间分异性以及揭示其背后驱动力的空间分析方法[15],该方法的因子探测器适用于探究驱动因子对耦合协调关系的影响。在已有研究的基础上[10]本文选取6项指标的探测因子,且在软件ArcMap 10.4中对相应因子进行自然间断点分级,共分为5个等级计算因子影响力。检验水准α=0.05。
通过应用SPSSPRO软件进行熵权TOPSIS法及耦合协调度分析,本研究评估了2015至2021年间江苏省医疗资源配置指数、服务利用指数以及它们的耦合协调度(图1)和相对发展度(图2)。结果表明,江苏省医疗资源配置指数持续上升,尽管新冠疫情导致短期波动,但上升趋势未受影响,预计未来将进入快速发展期。服务利用指数在2015至2019年间缓慢增长,但2020年回落;尽管如此,服务利用指数预计将恢复并提升至0.6。2021年耦合协调度为0.813,显示出良好的协调状态,且迅速恢复至优质协调。相对发展度分析揭示,江苏省从2015—2018年的资源滞后超前型转变为2019年的同步发展型,2020年起变为资源超前型,而2021年显著下降至2.24,可能预示回归同步发展阶段。
根据表3分析表明,2019年南京指数最高为0.758,而2016年盐城最低为0.215,苏南地区整体优于苏中和苏北。时间上显示,局部城市如南通出现微弱上升趋势,南京和泰州在2020年之前上升,之后下降。无锡至常州等排名前五的城市出现倒退现象,其他城市则在一定区间内波动。南京持续领先,其次是苏南的苏州和无锡,徐州作为苏北城市紧随其后。苏中地区的南通和泰州排名接近,扬州则不如二者。总结来看,2015至2021年间,江苏省市间存在显著差异,且整体发展态势不甚理想。
图3显示,江苏省服务利用指数普遍高于资源配置指数,且变化趋势更平缓。这表明医疗资源配置是减少市间差距的关键。进一步分析发现,2015至2021年间,苏中的扬州、苏北的淮安和盐城、苏南的镇江在资源配置方面明显低于同区域内其他城市。因此,重点关注这些城市可促进江苏省的均衡发展。
参考表2表4表5,对江苏省各市耦合协调发展空间分布特征及类型演化进行分析。
基于经济发展水平和卫生资源丰富程度及利用程度,将江苏省划分为四大类型地区:
核心引领型地区(南京、苏州、无锡):南京、苏州和无锡作为江苏省的医疗中心、经济中心和经济强市,其耦合协调度保持领先。
稳健发展型地区(常州、南通、泰州):常州、南通和泰州在医疗资源配置与服务利用方面表现稳健,但综合得分指数排名较核心引领型地区差距较大。
潜力挖掘型地区(宿迁、连云港、盐城等):这些地区在医疗资源配置与服务利用方面存在不足,需要加大投入和提升水平。多为资源滞后超前型和均为失调地区,表明其耦合协调度有待提高,需要进一步挖掘潜力,提升医疗资源配置与服务利用水平。
特色发展型地区(徐州):徐州作为淮海经济区的中心城市,具有独特的医疗发展特色,医疗资源相对丰富,医疗水平较高,在医疗资源配置与服务利用方面表现突出。
研究表明(表6),人口密度和城镇化率在1%~5%水平上显著影响耦合协调度,居民收入和非农产业占比在5%~10%水平上有显著影响,人均GDP和交通可达性无显著影响。主要影响因子解释力度集中在0.7~0.9,预计人口密度和城镇化率将继续是关键影响因素。
研究发现,江苏省地区间耦合协调度极不平衡,失调地区主要位于中部和东北部,协调地区则位于南部和西北部。结合地理探测器结果,据此提出以下相应的建议:①关注人口分布,协调资源配置。各市政府需科学分析人口分布及其发展趋势,调整医疗资源配置机制,同时考虑居民就医行为、资源辐射范围等因素,制定相关政策。②考虑区域经济发展和个人财富积累。政府财政政策应关注经济相对欠发达地区,促进多中心城市发展,提高当地经济水平,提供更多就业岗位,提高居民收入。③提升医疗资源配置。潜力挖掘型地区或可从此方面着手以推进各自的医疗资源配置与服务利用的综合发展,促进均衡发展。④兼顾协调发展。各地政府应互帮互助,考虑医疗人才的流通,推进互联网诊疗平台建设,实现跨区域诊疗,同时实施结合各城市特点的资源配置政策。
根据江苏省的研究结果,据此推演全国现状。人口分布与经济发展水平差异、城乡差异和区域差异影响医疗资源配置与利用。针对上述问题,本文提出以下政策建议:①实施差异化卫生资源配置政策。对于人口城镇化率这一显著影响协调度空间分异的影响因子,可根据不同地区的经济水平和人口分布情况,制定差异化的卫生资源配置政策。经济发达、人口密集的地区,重点提升医疗服务质量和水平;对于经济欠发达、人口稀疏的地区,则重点加强基础设施建设。此外,依据已有研究[16],考虑增加舒适物、促进经济发展以吸引人才长期居留。②建立区域卫生资源共享机制。通过远程医疗、智慧医疗等建立区域卫生协作平台,促进区域间的卫生资源优化配置和合理利用,提高医疗服务效率和水平。③制定和完善相关政策法规。明确各级政府在卫生资源配置和利用中的职责和权力,通过加强政策引导和规范管理[17],推动卫生资源的合理配置和有效利用。④加大对卫生事业的财政投入力度,确保卫生资源配置和利用的可持续性,加强财政资金的监管和使用效益评估。
在医疗资源相对紧缺的情景下,为优化整体医疗服务效率,一个可行策略是将医疗资源优先配置给需求较大的城镇地区,以提高医疗资源可及性和利用率。然而,居民收入水平对医疗资源供给及服务质量有着显著影响。具体来说,经济条件较好的区域或群体,往往能够吸引更多高质量的医疗设施和专业人才,进而提升当地医疗服务的整体水平。这种趋势虽然有助于提高医疗服务的可及性,但同时也可能加剧区域间和城乡间的不平衡状态,进一步扩大差距。而居民收入影响就医选择,导致资源与服务利用不协调。相比之下人均GDP对医疗资源影响不显著,可能因高产值对应高物价,而医疗资源必需且珍贵。非农产业占比显著影响,侧面反映人口分布对医疗资源配置与服务利用的重要性。农业机械化减少农业劳动力,增加二三产业人口,导致人口密度增加或城镇化率提高。
综上,本文从系统角度出发,采用协调度和地理分析方法对影响因子进行探测,揭示空间分异,量化影响程度。同时,本文考虑空间因素,为政策制定提供科学依据。本文还存在一定的局限性,例如:对于具体影响路径和机制尚未深入探究,未来可考虑人口城镇化率以及居民人均可支配收入等关键因素,对协调发展的具体影响路径和机制开展深入的研究。
  • 江苏高校哲学社会科学研究重大项目(2024SJZD062)
  • 大学生创新创业训练计划项目(202410313111Y)
  • 江苏省卫生健康委医学科研重点项目(ZD2022044)
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2025年第52卷第6期
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doi: 10.20043/j.cnki.MPM.202409456
  • 接收时间:2024-09-25
  • 首发时间:2026-03-18
  • 出版时间:2025-03-25
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  • 收稿日期:2024-09-25
基金
江苏高校哲学社会科学研究重大项目(2024SJZD062)
大学生创新创业训练计划项目(202410313111Y)
江苏省卫生健康委医学科研重点项目(ZD2022044)
江苏省卫计委预防医学科研课题(Y12023008)
作者信息
    1.徐州医科大学,江苏 徐州 221000
    2.徐州市中心医院

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孙玲,E-mail:
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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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