Article(id=1241034449467527614, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412270, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1734105600000, receivedDateStr=2024-12-14, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773815270057, onlineDateStr=2026-03-18, pubDate=1749484800000, pubDateStr=2025-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773815270057, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773815270057, creator=13701087609, updateTime=1773815270057, updator=13701087609, issue=Issue{id=1241034441380917539, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773815268130, creator=13701087609, updateTime=1773815340947, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241034746873049765, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241034746873049766, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2052, endPage=2057, ext={EN=ArticleExt(id=1241034449849209312, articleId=1241034449467527614, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Research on the coordination of child health care services and pediatric medical resource allocation in Guangdong Province, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the degree of coupling and coordination between child health care services and pediatric medical resource allocation in Guangdong Province from 2012 to 2020, providing a reference for promoting the coordinated development.

Methods

Data on relevant indicators of child health care services and pediatric medical resource allocation from 2012 to 2020 were selected. A comprehensive evaluation was conducted using a comprehensive development index and relative development degree. The coupling coordination model was employed to analyze the coupling coordination between the two systems. Cold and hot spot analysis was utilized to explore the spatial and temporal clustering characteristics of the two systems.

Results

There were significant regional differences in the development levels of child health care services and pediatric medical resources in Guangdong Province from 2012 to 2020, with the relative development degree consistently exceeding 1.2, indicating a lagging configuration of pediatric medical resource allocation. The coupling coordination type transitioned from a severely unbalanced and declining state to a barely coordinated state. Hotspot analysis revealed that from 2012 to 2020, the hotspot areas for the coupling coordination degree of the two systems included Guangzhou, Dongguan, and Shenzhen, with the clustering effect gradually strengthening and expanding southward.

Conclusion

It is essential to enhance the precision of pediatric resource allocation and reduce the disparities in development levels among regions. A macro perspective on the overall structure of child health care services should be adopted to achieve coordinated development between child health care services and pediatric medical resource allocation.

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目的

分析2012—2020年广东省儿童保健服务与儿科医疗资源配置的耦合协调程度,为促进二者协调发展提供参考。

方法

选取2012—2020年儿童保健服务及儿科医疗资源配置相关指标数据。采用综合发展指数、相对发展度对儿童保健服务与儿科医疗资源配置进行综合评价。利用耦合协调度模型分析两系统的耦合协调情况。使用冷热点分析探究两系统时空聚集性特征。

结果

2012—2020年广东省儿童保健服务与儿科医疗资源发展水平存在明显地区差异,且相对发展度持续高于1.2,整体结构为儿科医疗资源配置滞后型;耦合协调类型从严重失调衰退型向勉强耦合协调型过渡;冷热点分析结果显示,2012—2020年两系统耦合协调度热点区域均包括广州、东莞、深圳,且聚集效应逐渐增强并逐步向南扩充。

结论

提升儿科资源配置的精确性,缩小地区间发展水平差异;从宏观上考虑儿童医疗卫生服务整体架构,实现儿童保健服务与儿科医疗资源配置协调发展。

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姚卫光,E-mail::
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蔡梓琪(2001—),女,硕士在读,研究方向:卫生资源配置、卫生管理与政策研究

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蔡梓琪(2001—),女,硕士在读,研究方向:卫生资源配置、卫生管理与政策研究

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Chinese Health Service Management, 2021, 38(12): 881-887.(In Chinese), articleTitle=Analysis of the coupling coordination degree between medical service level and economic development level in Chongqing, refAbstract=null)], funds=[Fund(id=1241050836080578918, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449467527614, awardId=GD22CGL17, language=CN, fundingSource=广东省哲学社会科学规划2022年度一般项目(GD22CGL17), fundOrder=null, country=null), Fund(id=1241050836198019437, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449467527614, awardId=2024-2026, language=CN, fundingSource=广州公共卫生服务体系建设研究基地资助项目(2024-2026), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241050829789122616, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449467527614, xref=null, ext=[AuthorCompanyExt(id=1241050829797511228, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449467527614, companyId=1241050829789122616, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Southern Medical University, School of Health Management, Guangzhou, Guangdong 510515, China), AuthorCompanyExt(id=1241050829810094140, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449467527614, companyId=1241050829789122616, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=南方医科大学卫生管理学院,广东 广州 510515)])], figs=[ArticleFig(id=1241050833404612868, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449467527614, language=EN, label=Figure 1, caption=Coupling and coordination of the two systems in Guangdong Province, 2012—2020, figureFileSmall=4qP9IhH3zxKZLEbL0FP/lQ==, figureFileBig=0I409cNHkIlhcfjGaJbb5Q==, tableContent=null), ArticleFig(id=1241050833551413522, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449467527614, language=CN, label=图1, caption=2012—2020年广东省两系统耦合协调度, figureFileSmall=4qP9IhH3zxKZLEbL0FP/lQ==, figureFileBig=0I409cNHkIlhcfjGaJbb5Q==, tableContent=null), ArticleFig(id=1241050833882763549, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449467527614, language=EN, label=Table 1, caption=

Evaluation index system of child health care services and pediatric medical resource allocation in Guangdong Province

, figureFileSmall=null, figureFileBig=null, tableContent=
系统名称具体指标指标权重方向
儿童保健服务新生儿死亡率
0.059 1-
婴儿死亡率0.063 6-
5岁以下儿童死亡率0.070 5-
新生儿访视率0.033 2+
7岁以下儿童保健覆盖率0.027 0+
3岁以下儿童系统管理率0.019 4+
低体重率0.038 8-
儿科医疗资源儿科床位数0.278 9+
儿科执业(助理)医师数0.409 5+
), ArticleFig(id=1241050834029564206, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449467527614, language=CN, label=表1, caption=

广东省儿童保健服务与儿科医疗资源配置评价指标体系

, figureFileSmall=null, figureFileBig=null, tableContent=
系统名称具体指标指标权重方向
儿童保健服务新生儿死亡率
0.059 1-
婴儿死亡率0.063 6-
5岁以下儿童死亡率0.070 5-
新生儿访视率0.033 2+
7岁以下儿童保健覆盖率0.027 0+
3岁以下儿童系统管理率0.019 4+
低体重率0.038 8-
儿科医疗资源儿科床位数0.278 9+
儿科执业(助理)医师数0.409 5+
), ArticleFig(id=1241050834243473723, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449467527614, language=EN, label=Table 2, caption=

Comprehensive development index and coupling coordination of the two systems in cities and towns in Guangdong Province, 2012—2020

, figureFileSmall=null, figureFileBig=null, tableContent=
地区地市2012年2013年2014年2015年2016年2017年2018年2019年2020年
S1S2D E S1S2D E S1S2D E S1S2D ES1S2D E S1S2D E S1S2D E S1S2D E S1S2D E
珠三角广州0.1140.3890.4570.2930.1420.4520.5030.3140.1470.4620.5100.3180.1650.5040.5370.3280.1890.5550.5690.3410.1920.5750.5770.3340.1840.6240.5820.2950.2090.6710.6120.3110.2280.6740.6260.338
深圳0.1810.1920.4320.9440.1730.2230.4430.7720.1820.2330.4540.7820.1970.2660.4780.7420.2130.2890.4980.7390.2320.3110.5180.7450.2420.3440.5370.7020.2560.3890.5620.6570.2740.3950.5740.693
珠海0.1880.0130.22314.2540.1760.0190.2409.2900.1500.0200.2347.4860.1820.0250.2617.1440.1720.0290.2665.9030.1690.0340.2764.9010.1950.0410.2994.7670.2120.0470.3164.5160.2260.0480.3234.676
佛山0.1150.1150.3390.9960.1540.1410.3841.0940.1430.1500.3830.9580.1950.1690.4261.1550.2020.1830.4381.1060.2120.1930.4501.1020.2050.2130.4570.9640.2030.2220.4610.9130.2350.2200.4771.069
江门0.0560.0520.2321.0820.0560.0660.2460.8370.1720.0690.3292.5060.2290.0840.3722.7400.2330.0910.3822.5500.2530.0980.3972.5840.2560.1040.4042.4550.2470.1110.4072.2360.2360.1120.4032.109
东莞0.1900.1170.3861.6190.1620.1400.3881.1560.2030.1410.4111.4360.2090.1550.4241.3550.2180.1640.4351.3360.2130.1720.4381.2350.1970.1910.4411.0340.2030.2060.4530.9850.2370.2060.4701.152
中山0.1780.0280.2666.3010.1890.0400.2954.7220.1870.0440.3014.2780.1720.0480.3023.5580.1740.0550.3133.1340.1860.0640.3302.9350.1940.0710.3422.7440.2170.0750.3582.8880.2240.0740.3593.012
肇庆0.1090.0280.2353.9110.1250.0420.2692.9920.1710.0440.2953.8480.1720.0530.3093.2180.1650.0600.3162.7310.1510.0640.3142.3470.1740.0710.3332.4540.1860.0760.3452.4370.1780.0750.3402.365
惠州0.2250.0660.3493.4040.2430.0860.3802.8350.1860.0890.3592.0870.2170.1000.3842.1630.1830.1090.3751.6820.2100.1160.3951.8060.2090.1190.3971.7530.2020.1250.4001.6100.2260.1300.4141.744
粤 东汕头0.2390.0500.3314.7510.2340.0640.3493.6600.2620.0650.3614.0400.2710.0690.3703.9120.2700.0790.3823.4150.2540.0830.3823.0550.2350.0920.3832.5650.2530.0970.3962.5980.2620.0970.3992.699
汕尾0.1910.0010.20819.2960.2120.0160.24013.580.1510.0150.21810.0400.1870.0170.23810.8970.2260.0210.26310.6030.2230.0250.2748.8620.2230.0290.2837.7480.2200.0260.2748.5790.2320.0270.2818.699
潮州0.2130.0030.15871.9850.2580.0070.20835.4430.2650.0080.21532.8530.2870.0100.23327.8940.2740.0120.23923.0230.2170.0140.23415.6820.1970.0140.22914.1440.2130.0180.24911.7800.2760.0180.26615.118
揭阳0.1390.0440.2803.1640.1660.0520.3043.2190.1650.0560.3102.9490.1910.0740.3442.5920.2020.0810.3582.4950.1770.0870.3522.0300.1680.0940.3551.7850.1520.0980.3491.5610.1920.0990.3721.935
粤 西湛江0.1510.0900.3411.6770.1990.1160.3891.7170.2040.1210.3961.6900.1890.1390.4021.3590.1810.1460.4031.2410.1950.1550.4171.2600.1990.1670.4271.1920.1930.1710.4261.1310.2120.1750.4391.209
茂名0.1200.0780.3111.5370.1400.0960.3401.4550.1800.1090.3741.6460.1470.1240.3671.1870.2090.1430.4161.4590.2080.1540.4231.3460.2030.1640.4271.2340.1890.1630.4191.1530.1680.1590.4051.058
阳江0.1310.0070.17518.3600.1600.0160.2269.7140.1610.0200.2388.0050.1570.0260.2535.9820.1630.0300.2645.4760.1080.0370.2522.9030.1260.0440.2732.8780.1050.0480.2662.1740.1770.0480.3033.698
粤 北韶关0.1230.0380.2613.2700.1250.0510.2822.4580.1350.0520.2892.6300.1700.0580.3162.9050.1260.0640.3001.9740.1560.0640.3162.4400.1300.0700.3091.8530.1210.0720.3061.6770.1640.0700.3282.332
梅州0.1630.0440.2963.4990.1480.0620.3102.3780.1610.0660.3202.4500.1710.0730.3352.3300.1960.0790.3532.4740.1420.0810.3281.7490.1010.0850.3041.1870.1470.0890.3371.6550.1610.0890.3451.815
河源0.1940.0140.22614.3350.2060.0240.2658.6390.2020.0220.2589.2340.2170.0350.2956.2190.2250.0420.3125.3350.2090.0450.3114.6410.1800.0510.3103.5010.1740.0590.3192.9360.1670.0610.3182.756
清远0.1380.0360.2663.8300.1350.0480.2852.7920.1570.0510.2993.0830.2020.0580.3293.5150.1950.0620.3323.1410.1800.0640.3272.8350.1370.0700.3131.9550.1370.0800.3231.7080.1960.0780.3512.519
云浮0.1510.0030.14946.7320.1670.0090.19917.8580.2030.0110.21518.8680.1990.0140.23113.9160.1610.0190.2358.4360.0740.0220.2013.3550.1240.0250.2355.0360.1610.0270.2575.9740.1690.0290.2645.888
广东省0.3630.0020.054151.1400.3840.0460.3648.4100.3980.0570.3887.0260.4310.0960.4514.4960.4210.1310.4843.2160.3650.1560.4892.3350.3010.1930.4911.5620.3660.2280.5371.6060.5520.2350.6002.350
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2012—2020年广东省各地市两系统综合发展指数和耦合协调情况

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地区地市2012年2013年2014年2015年2016年2017年2018年2019年2020年
S1S2D E S1S2D E S1S2D E S1S2D ES1S2D E S1S2D E S1S2D E S1S2D E S1S2D E
珠三角广州0.1140.3890.4570.2930.1420.4520.5030.3140.1470.4620.5100.3180.1650.5040.5370.3280.1890.5550.5690.3410.1920.5750.5770.3340.1840.6240.5820.2950.2090.6710.6120.3110.2280.6740.6260.338
深圳0.1810.1920.4320.9440.1730.2230.4430.7720.1820.2330.4540.7820.1970.2660.4780.7420.2130.2890.4980.7390.2320.3110.5180.7450.2420.3440.5370.7020.2560.3890.5620.6570.2740.3950.5740.693
珠海0.1880.0130.22314.2540.1760.0190.2409.2900.1500.0200.2347.4860.1820.0250.2617.1440.1720.0290.2665.9030.1690.0340.2764.9010.1950.0410.2994.7670.2120.0470.3164.5160.2260.0480.3234.676
佛山0.1150.1150.3390.9960.1540.1410.3841.0940.1430.1500.3830.9580.1950.1690.4261.1550.2020.1830.4381.1060.2120.1930.4501.1020.2050.2130.4570.9640.2030.2220.4610.9130.2350.2200.4771.069
江门0.0560.0520.2321.0820.0560.0660.2460.8370.1720.0690.3292.5060.2290.0840.3722.7400.2330.0910.3822.5500.2530.0980.3972.5840.2560.1040.4042.4550.2470.1110.4072.2360.2360.1120.4032.109
东莞0.1900.1170.3861.6190.1620.1400.3881.1560.2030.1410.4111.4360.2090.1550.4241.3550.2180.1640.4351.3360.2130.1720.4381.2350.1970.1910.4411.0340.2030.2060.4530.9850.2370.2060.4701.152
中山0.1780.0280.2666.3010.1890.0400.2954.7220.1870.0440.3014.2780.1720.0480.3023.5580.1740.0550.3133.1340.1860.0640.3302.9350.1940.0710.3422.7440.2170.0750.3582.8880.2240.0740.3593.012
肇庆0.1090.0280.2353.9110.1250.0420.2692.9920.1710.0440.2953.8480.1720.0530.3093.2180.1650.0600.3162.7310.1510.0640.3142.3470.1740.0710.3332.4540.1860.0760.3452.4370.1780.0750.3402.365
惠州0.2250.0660.3493.4040.2430.0860.3802.8350.1860.0890.3592.0870.2170.1000.3842.1630.1830.1090.3751.6820.2100.1160.3951.8060.2090.1190.3971.7530.2020.1250.4001.6100.2260.1300.4141.744
粤 东汕头0.2390.0500.3314.7510.2340.0640.3493.6600.2620.0650.3614.0400.2710.0690.3703.9120.2700.0790.3823.4150.2540.0830.3823.0550.2350.0920.3832.5650.2530.0970.3962.5980.2620.0970.3992.699
汕尾0.1910.0010.20819.2960.2120.0160.24013.580.1510.0150.21810.0400.1870.0170.23810.8970.2260.0210.26310.6030.2230.0250.2748.8620.2230.0290.2837.7480.2200.0260.2748.5790.2320.0270.2818.699
潮州0.2130.0030.15871.9850.2580.0070.20835.4430.2650.0080.21532.8530.2870.0100.23327.8940.2740.0120.23923.0230.2170.0140.23415.6820.1970.0140.22914.1440.2130.0180.24911.7800.2760.0180.26615.118
揭阳0.1390.0440.2803.1640.1660.0520.3043.2190.1650.0560.3102.9490.1910.0740.3442.5920.2020.0810.3582.4950.1770.0870.3522.0300.1680.0940.3551.7850.1520.0980.3491.5610.1920.0990.3721.935
粤 西湛江0.1510.0900.3411.6770.1990.1160.3891.7170.2040.1210.3961.6900.1890.1390.4021.3590.1810.1460.4031.2410.1950.1550.4171.2600.1990.1670.4271.1920.1930.1710.4261.1310.2120.1750.4391.209
茂名0.1200.0780.3111.5370.1400.0960.3401.4550.1800.1090.3741.6460.1470.1240.3671.1870.2090.1430.4161.4590.2080.1540.4231.3460.2030.1640.4271.2340.1890.1630.4191.1530.1680.1590.4051.058
阳江0.1310.0070.17518.3600.1600.0160.2269.7140.1610.0200.2388.0050.1570.0260.2535.9820.1630.0300.2645.4760.1080.0370.2522.9030.1260.0440.2732.8780.1050.0480.2662.1740.1770.0480.3033.698
粤 北韶关0.1230.0380.2613.2700.1250.0510.2822.4580.1350.0520.2892.6300.1700.0580.3162.9050.1260.0640.3001.9740.1560.0640.3162.4400.1300.0700.3091.8530.1210.0720.3061.6770.1640.0700.3282.332
梅州0.1630.0440.2963.4990.1480.0620.3102.3780.1610.0660.3202.4500.1710.0730.3352.3300.1960.0790.3532.4740.1420.0810.3281.7490.1010.0850.3041.1870.1470.0890.3371.6550.1610.0890.3451.815
河源0.1940.0140.22614.3350.2060.0240.2658.6390.2020.0220.2589.2340.2170.0350.2956.2190.2250.0420.3125.3350.2090.0450.3114.6410.1800.0510.3103.5010.1740.0590.3192.9360.1670.0610.3182.756
清远0.1380.0360.2663.8300.1350.0480.2852.7920.1570.0510.2993.0830.2020.0580.3293.5150.1950.0620.3323.1410.1800.0640.3272.8350.1370.0700.3131.9550.1370.0800.3231.7080.1960.0780.3512.519
云浮0.1510.0030.14946.7320.1670.0090.19917.8580.2030.0110.21518.8680.1990.0140.23113.9160.1610.0190.2358.4360.0740.0220.2013.3550.1240.0250.2355.0360.1610.0270.2575.9740.1690.0290.2645.888
广东省0.3630.0020.054151.1400.3840.0460.3648.4100.3980.0570.3887.0260.4310.0960.4514.4960.4210.1310.4843.2160.3650.1560.4892.3350.3010.1930.4911.5620.3660.2280.5371.6060.5520.2350.6002.350
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Cold hotspots of two-system coupling coordination in Guangdong Province, 2012—2020

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年份(年)分布类型数量(个)地市
2012热点5广州**、深圳**、东莞**、中山*、惠州*
2013热点4广州**、深圳**、东莞**、惠州*
2014热点4广州**、深圳*、东莞*、中山*
2015热点4广州**、深圳*、东莞*、中山*
2016热点4广州*、深圳*、东莞*、中山*
2017热点4广州**、深圳*、东莞*、中山*
2018热点4广州**、深圳*、东莞*、中山**
2019热点4广州**、深圳**、东莞**、中山**
2020热点4广州**、深圳**、东莞**、中山**
), ArticleFig(id=1241050835430461782, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449467527614, language=CN, label=表3, caption=

2012—2020年广东省两系统耦合协调度冷热点地区

, figureFileSmall=null, figureFileBig=null, tableContent=
年份(年)分布类型数量(个)地市
2012热点5广州**、深圳**、东莞**、中山*、惠州*
2013热点4广州**、深圳**、东莞**、惠州*
2014热点4广州**、深圳*、东莞*、中山*
2015热点4广州**、深圳*、东莞*、中山*
2016热点4广州*、深圳*、东莞*、中山*
2017热点4广州**、深圳*、东莞*、中山*
2018热点4广州**、深圳*、东莞*、中山**
2019热点4广州**、深圳**、东莞**、中山**
2020热点4广州**、深圳**、东莞**、中山**
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广东省儿童保健服务与儿科医疗资源配置的协调度研究
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蔡梓琪 , 姚卫光
现代预防医学 | 卫生政策与管理 2025,52(11): 2052-2057
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现代预防医学 | 卫生政策与管理 2025, 52(11): 2052-2057
广东省儿童保健服务与儿科医疗资源配置的协调度研究
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蔡梓琪, 姚卫光
作者信息
  • 南方医科大学卫生管理学院,广东 广州 510515
  • 蔡梓琪(2001—),女,硕士在读,研究方向:卫生资源配置、卫生管理与政策研究

通讯作者:

姚卫光,E-mail::
Research on the coordination of child health care services and pediatric medical resource allocation in Guangdong Province
Zi-qi CAI, Wei-guang YAO
Affiliations
  • Southern Medical University, School of Health Management, Guangzhou, Guangdong 510515, China
出版时间: 2025-06-10 doi: 10.20043/j.cnki.MPM.202412270
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目的

分析2012—2020年广东省儿童保健服务与儿科医疗资源配置的耦合协调程度,为促进二者协调发展提供参考。

方法

选取2012—2020年儿童保健服务及儿科医疗资源配置相关指标数据。采用综合发展指数、相对发展度对儿童保健服务与儿科医疗资源配置进行综合评价。利用耦合协调度模型分析两系统的耦合协调情况。使用冷热点分析探究两系统时空聚集性特征。

结果

2012—2020年广东省儿童保健服务与儿科医疗资源发展水平存在明显地区差异,且相对发展度持续高于1.2,整体结构为儿科医疗资源配置滞后型;耦合协调类型从严重失调衰退型向勉强耦合协调型过渡;冷热点分析结果显示,2012—2020年两系统耦合协调度热点区域均包括广州、东莞、深圳,且聚集效应逐渐增强并逐步向南扩充。

结论

提升儿科资源配置的精确性,缩小地区间发展水平差异;从宏观上考虑儿童医疗卫生服务整体架构,实现儿童保健服务与儿科医疗资源配置协调发展。

儿童保健服务  /  儿科医疗资源  /  耦合协调  /  广东
Objective

To analyze the degree of coupling and coordination between child health care services and pediatric medical resource allocation in Guangdong Province from 2012 to 2020, providing a reference for promoting the coordinated development.

Methods

Data on relevant indicators of child health care services and pediatric medical resource allocation from 2012 to 2020 were selected. A comprehensive evaluation was conducted using a comprehensive development index and relative development degree. The coupling coordination model was employed to analyze the coupling coordination between the two systems. Cold and hot spot analysis was utilized to explore the spatial and temporal clustering characteristics of the two systems.

Results

There were significant regional differences in the development levels of child health care services and pediatric medical resources in Guangdong Province from 2012 to 2020, with the relative development degree consistently exceeding 1.2, indicating a lagging configuration of pediatric medical resource allocation. The coupling coordination type transitioned from a severely unbalanced and declining state to a barely coordinated state. Hotspot analysis revealed that from 2012 to 2020, the hotspot areas for the coupling coordination degree of the two systems included Guangzhou, Dongguan, and Shenzhen, with the clustering effect gradually strengthening and expanding southward.

Conclusion

It is essential to enhance the precision of pediatric resource allocation and reduce the disparities in development levels among regions. A macro perspective on the overall structure of child health care services should be adopted to achieve coordinated development between child health care services and pediatric medical resource allocation.

Child health care services  /  Pediatric medical resources  /  Coupling coordination  /  Guangdong
蔡梓琪, 姚卫光. 广东省儿童保健服务与儿科医疗资源配置的协调度研究. 现代预防医学, 2025 , 52 (11) : 2052 -2057 . DOI: 10.20043/j.cnki.MPM.202412270
Zi-qi CAI, Wei-guang YAO. Research on the coordination of child health care services and pediatric medical resource allocation in Guangdong Province[J]. Modern Preventive Medicine, 2025 , 52 (11) : 2052 -2057 . DOI: 10.20043/j.cnki.MPM.202412270
儿童健康事关国家发展大计,是国家基本医疗保健的重要组成部分[1-2]。2024年1月,国务院办公厅发布的《关于推进儿童医疗卫生服务高质量发展的意见》中指出通过强化儿童保健服务网络建设和优化儿童医疗资源配置构建高质量儿童医疗卫生服务体系[3]。事实上,两者存在一定耦合关联,一方面,儿童保健服务的质量提升能够减少儿科疾病的发生率,从而减轻儿科医疗资源的压力;另一方面,儿科医疗资源的优化配置又能够为儿童保健服务提供技术支持和质量保障。二者相互促进、协调发展将有助于提升儿童医疗卫生服务质量及效率,实现儿童医疗卫生资源效益最大化[4]。目前,已有研究探讨儿科医疗服务现状[5]、儿童保健服务的公平性[6]、儿科医疗资源的配置效率[7-8]等,对于两者耦合协调关系研究较少。基于此,本研究回顾性探索2012—2020年广东省儿童保健服务与儿科医疗资源配置的耦合协调情况,评价其相对发展状况与时空聚集特征,为促进二者优质协调发展提供参考。
本研究的原始数据均来源于2012—2015年《广东省卫生统计年鉴》、2016—2017年《广东省卫生和计划生育统计年鉴》、2018—2020年《广东省卫生健康统计年鉴》,数据无缺失值。其中,儿科执业(助理)医师数与儿科床位数通过医疗卫生机构执业(助理)医师数、儿科执业(助理)医师占医疗卫生机构执业(助理)医师的百分比、医疗卫生机构床位数、儿科床位数占比等原始数据运算得出。本研究所称的“儿科”包括儿科、小儿外科和儿童保健科等科室;统计范围包括医院、基层医疗卫生机构、妇幼保健院和专科疾病防治院。
根据《关于推进儿童医疗卫生服务高质量发展的意见》等政策并参考相关研究[7],遵循指标选取的科学性和可获得性原则,将新生儿死亡率、婴儿死亡率、5岁以下儿童死亡率、新生儿访视率、7岁以下儿童保健覆盖率、3岁以下儿童系统管理率和低体重率共七个指标作为儿童保健服务的评价指标;选取儿科床位数、儿科执业(助理)医师数作为儿科医疗资源配置的评价指标,具体见表1。各指标均采用均数或比率形式表示。
本研究首先借鉴王青[9]的标准化公式对指标进行标化处理,采用熵权法赋予指标权重。见表1
基于熵权法确定的各评价指标权重,运用线性加权法分别计算儿童保健服务利用与儿科医疗资源配置的综合发展指数。计算公式如下:
将儿童保健服务与儿科医疗资源配置视为两个耦合的系统,计算耦合协调度D判断两系统间的协调关系。
其中,D为耦合协调度,C为耦合度,取值范围均为[0,1];S1、S2分别代表两系统的综合发展指数;T为综合协调指数,α、β为发展系数,满足α+β=1,本研究认为两系统同等重要,故α=β=0.5。
借鉴已有研究成果[10],将耦合协调度划分为5个等级,0≤D≤0.2为严重失调衰退型、0.2<D≤0.4为中度失调衰退型、0.4<D≤0.6为勉强耦合协调型、0.6<D≤0.8为中度耦合协调型、0.8<D≤1.0为良好耦合协调型。
耦合协调度模型可用于评价系统间的协调关系,但难以评价其相对发展状况,故本文引入相对发展度模型。计算公式如下:
E≤0.8为儿童保健服务能力滞后型,0.8<E<1.2为两者协同发展型,E≥1.2为儿科医疗资源配置滞后型[11]
冷热点分析用于反映地区间两系统耦合协调的空间依赖性及异质性[12]。计算公式为:
热点区域Z值高且为正值,P值显著;冷点区域Z值低且为负值,P值显著;若Z值接近于0,则该地区不存在具有统计学意义的空间聚类[13]
儿童保健服务上,从时间维度看,2012—2020年广东省综合发展水平虽有波动,但总体呈上升趋势,从0.363上升至0.552。儿童保健服务水平位于平均水平之上的地市由2012年的10个上升至2020年的12个。从空间维度看,广东省各地市儿童保健服务综合发展水平存在明显的地区差异,主要表现为珠三角和粤东地区明显优于粤西和粤北地区。2012—2020年儿童保健服务综合发展水平最高与最低的城市分别是汕头和韶关。见表2
儿科医疗资源配置上,从时间维度看,2012—2020年广东省总体综合发展水平从0.002上升至0.235,呈稳步上升趋势。2012—2020年广州、深圳、佛山、东莞、湛江、茂名的儿科医疗资源配置水平始终位于平均水平之上。从空间维度看,2012—2020年儿科医疗资源配置水平最高与最低的城市分别是广州和潮州。值得关注的是,潮州、汕尾、云浮这3个城市儿科医疗资源配置水平较低且发展缓慢。见表2
从相对发展度看,2012—2020年广东省两系统相对发展度持续高于1.2,为儿科医疗资源配置滞后型。2020年广东各地市相对发展度结构为“2-3-16”,广州、深圳的儿科医疗配置状况超前于儿童保健服务水平,佛山、茂名、东莞为协同发展型,其余地市儿科医疗资源配置滞后于儿童保健服务水平。
从总体上看,2012—2020年广东省两系统耦合协调度整体呈稳定上升态势,协调类型从严重失调衰退型向勉强耦合协调型过渡,表明两系统间的耦合性能趋于优化,但仍需进行适当干预使其向优质协调发展。见图1
从时间维度看,2012年广东省各地市两系统耦合协调度介于0.149~0.457,除广州、深圳外,其余地市均属于不同程度的失调衰退型。其中阳江、潮州、云浮属于严重失调衰退型,其余地市均属于中度失调衰退型。2020年广东省各地市耦合协调度有明显提升,耦合协调度介于0.264~0.626,未出现严重失调衰退型,深圳、佛山、江门、湛江、茂名、惠州、东莞7个城市属于勉强耦合协调型,而广州则跃升至中度耦合协调型城市。见表2
从空间维度看,2020年广东省珠三角、粤东、粤西、粤北地区中度失调衰退型城市数量分别为3、4、1、5;耦合协调型城市数量分别为6、0、1、0。由此可见,广东省耦合协调度存在明显地区差异,珠三角和粤西地区耦合协调度优于粤东和粤北地区。见表2
冷热点分析结果显示,广东省两系统耦合协调分布情况以珠三角地区的部分地市为热点区域,空间关系变化较小,其他地区呈现的空间局部聚集效应并不显著。2012—2020年广东省两系统耦合协调度热点区域均包括广州、东莞、深圳,为稳定性热点,且聚集效应逐渐增强并逐步向南扩充,如中山;2012—2020年全省儿童保健服务与儿科医疗资源配置耦合协调度冷点区域均不显著。见表3
2012—2020年广东省两系统综合发展水平整体呈上升趋势,但不同地市间存在明显差异。究其原因:一是珠三角地区因经济发达及医疗资源配置优化发展较快,而粤北地区受制于地方财政、人才匮乏、交通不便及开展儿童保健服务成本较高等因素[7],整体发展滞后。二是政策倾斜与资金投入等因素影响儿童保健服务水平,2019年粤东地区通过建立首个区域辐射型医联体快速提升儿童保健服务能力,其儿童保健服务水平跃居全省前列。三是儿科医生紧缺、技术水平不足与疾病谱改变、生育政策调整后带来的儿童数量增长[8]之间的矛盾导致广东省儿科医疗资源配置滞后。因此,除财政投入外,还应探索儿科医务人员、卫生技术等软件资源在地区之间、城乡之间的多样化转移与倾斜,发展儿科医联体与儿科联盟,鼓励优质医疗资源下沉;同时积极引导冗余儿科医疗资源流向欠发达偏远地区,保障财力资源纾困解贫、物力资源避免闲置、人力资源高效互动,助推儿童保健服务水平和儿科资源配置精确性的提升[4]
2012—2020年广东省两系统耦合协调关系向好发展,耦合协调类型从严重失调衰退型向勉强耦合协调型过渡,但仍有待提高。具体表现为珠三角和粤西地区协调度较好,其他地区亟待提升。其核心制约因素为两系统发展失衡及儿科医疗资源配置结构性矛盾。据统计,2012—2020年广东省儿科床位数与儿科执业(助理)医师数呈逐年增长趋势,且攀升速度较快;然而儿童人口数增多及家长对儿童的保健意识增强导致儿科医疗资源供不应求现象持续严峻。同时儿科人力资源与三级医院过多聚集于经济发达城市导致高医疗资源错配的产生[14],加剧了广东省儿科医疗资源配置不合理现象。高水平儿童保健服务更多是儿科医疗资源过多聚集而产生的结果,因此需要从宏观上考虑儿童医疗卫生服务整体架构,根据各地市儿童人口结构与分布、当地儿童就医行为、现有卫生状况、机构辐射能力和儿童健康需求等情况来合理配置儿科医疗资源[15]。此外,应大力推行分级诊疗,致力于区域间、区域内不同级别医院检验结果互认、医疗资源互通,从而促进上下级医院形成良性的双向互动;鼓励儿童家长基层首诊,提高基层医院儿科利用率,实现两系统协调发展。
广东省儿童保健服务与儿科医疗资源配置耦合协调水平呈现显著空间异质性,热点地区均集中于广州、东莞、深圳,聚集效应逐渐增强并出现向珠三角地区其他城市扩散的趋势。说明高协调度地市对邻近城市存在明显的空间溢出效应[11]。建议发挥热点地区区位优势,持续扩大耦合协调度水平较高地区的空间辐射作用,通过对点帮扶、合作联动等方式提升儿童保健服务水平和质量,加快优质儿科医疗资源扩容和区域均衡布局[16]。同时,耦合协调水平较低的城市可以根据本地实际积极调整两系统协调情况,学习相关发展经验,持续提升软硬实力[12],构建时空维度上更符合当地发展的儿童卫生服务体系。
自2021年起,统计年鉴中有关儿童保健服务部分只统计了新生儿访视率、7岁以下儿童保健覆盖率、3岁以下儿童系统管理率和低体重率四个指标,未对新生儿死亡率、婴儿死亡率和5岁以下儿童死亡率进行统计。故本文研究时段截至2020年,未能对最新时段的儿童保健服务及儿科医疗资源配置相关指标数据进行研究,因此分析评价具有一定的局限性,有待在后续研究中进一步完善。
  • 广东省哲学社会科学规划2022年度一般项目(GD22CGL17)
  • 广州公共卫生服务体系建设研究基地资助项目(2024-2026)
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2025年第52卷第11期
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doi: 10.20043/j.cnki.MPM.202412270
  • 接收时间:2024-12-14
  • 首发时间:2026-03-18
  • 出版时间:2025-06-10
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  • 收稿日期:2024-12-14
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广东省哲学社会科学规划2022年度一般项目(GD22CGL17)
广州公共卫生服务体系建设研究基地资助项目(2024-2026)
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    南方医科大学卫生管理学院,广东 广州 510515

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2种不同金属材料的力学参数

Family
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种数
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种数
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Percentage of total
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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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