Article(id=1241035819994108301, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035810628235909, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202405397, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1716393600000, receivedDateStr=2024-05-23, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773815596816, onlineDateStr=2026-03-18, pubDate=1733760000000, pubDateStr=2024-12-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773815596816, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773815596816, creator=13701087609, updateTime=1773815596816, updator=13701087609, issue=Issue{id=1241035810628235909, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='23', pageStart='4225', pageEnd='4416', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773815594584, creator=13701087609, updateTime=1773815743629, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241036435843764756, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035810628235909, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241036435843764757, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035810628235909, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=4321, endPage=4326, ext={EN=ArticleExt(id=1241035820501619108, articleId=1241035819994108301, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Research on the influencing factors and improvement paths of equity in the allocation of public health human resources in China based on fuzzy set qualitative comparative analysis, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the influencing factors and improvement paths for the equity of public health human resource allocation in China, providing references for accelerating the development of the public health talent workforce.

Methods

The study assessed the equity of public health human resource allocation in China from 2019 to 2021 through concentration degree evaluation and employed fuzzy set qualitative comparative analysis to investigate the pathways affecting its equity.

Results

There were 11 configurations in the high equity group for public health human resource allocation from 2019 to 2021, with a total consistency and total coverage of 0.97 (>0.8) and 0.66 (>0.5), respectively, indicating a strong explanatory power of the model. Population concentration emerged as a core condition across all configurations.

Conclusion

The equity of public health human resource allocation results from a combination of multiple factors, with identifiable key directions. Among these, population concentration is a core factor, while institutional allocation levels and government health expenditures serve as important leverage points. The synergistic effects among various elements, including institutions, individuals, society, and government, contribute to achieving high equity in public health human resource allocation.

, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Rui-zhao LU, Ling-bo HUANG, Yu-jie WU, Qi-ming FENG, Xin-hui HUANG, Si-wei SUN, Zhen LI), CN=ArticleExt(id=1241035823668318725, articleId=1241035819994108301, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=基于模糊集定性比较分析的中国公共卫生人力资源配置公平性影响因素与提升路径研究, columnId=1228016568014139551, journalTitle=现代预防医学, columnName=卫生政策与管理, runingTitle=null, highlight=null, articleAbstract=
目的

探究我国公共卫生人力资源配置公平性影响因素及提升路径,为加快公共卫生人才队伍建设提供借鉴与参考。

方法

采用集聚度评估2019—2021年全国公共卫生人力资源配置公平性,运用模糊集定性比较分析方法探讨影响其公平性的路径。

结果

2019—2021年公共卫生人力资源配置高公平性组态共有11条,总一致性和总覆盖度分别在0.97(>0.8)和0.66(>0.5)以上,模型解释力较强,人口集聚度作为核心条件出现在所有组态当中。

结论

公共卫生人力资源配置公平虽是多方因素综合作用的结果,但重点方向仍有迹可循,其中人口集聚度是核心因素,机构配置水平和政府卫生支出是重要抓手,机构、个人、社会和政府等多类要素间的协同作用有助于实现公共卫生人力资源配置高公平性。

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李贞,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=JQMw7NrqtFmmQX+zVArirw==, magXml=8d2/DQO9lM1o0PN2BQ/CXA==, pdfUrl=null, pdf=qVheGCmccQkjLZOev1vFmw==, pdfFileSize=1003467, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=EgzMoCBJs33XjwxheRyHww==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=nqgx/NIcfdeyRkXE8IoUtQ==, mapNumber=null, authorCompany=null, fund=null, authors=

陆瑞钊(2001—),男,硕士在读,研究方向:卫生人力资源

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陆瑞钊(2001—),男,硕士在读,研究方向:卫生人力资源

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陆瑞钊(2001—),男,硕士在读,研究方向:卫生人力资源

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Chinese Health Economics, 2023, 42(2): 46-52.(In Chinese), articleTitle=Research on the Equity of health resources allocation in professional public health institutions in Guangdong prov-ince from the perspective of regional comparison, refAbstract=null)], funds=[Fund(id=1241069124328157908, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, awardId=2020JJB180002, language=CN, fundingSource=广西自然科学基金(2020JJB180002), fundOrder=null, country=null), Fund(id=1241069124424626908, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, awardId=2022QGRW015, language=CN, fundingSource=广西高等学校千名中青年骨干教师培育计划(2022QGRW015), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241069116270899466, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, xref=1., ext=[AuthorCompanyExt(id=1241069116275093771, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, companyId=1241069116270899466, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Information and Management, Guangxi Medical University, Nanning, Guangxi 530021, China), AuthorCompanyExt(id=1241069116283482381, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, companyId=1241069116270899466, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.广西医科大学卫生与健康政策研究中心(广西高端智库建设培育单位),广西 南宁 530021)]), AuthorCompany(id=1241069116405117209, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, xref=2., ext=[AuthorCompanyExt(id=1241069116413505819, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, companyId=1241069116405117209, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.广西医科大学信息与管理学院,广西 南宁 530021)])], figs=[ArticleFig(id=1241069121706717825, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, language=EN, label=Figure 1, caption=Conditional variable and outcome variable selection, figureFileSmall=yLX/tBtx8Bx8vhr/2t0glg==, figureFileBig=tMJQr9oOjPZQza4EtyPzKA==, tableContent=null), ArticleFig(id=1241069121853518471, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, language=CN, label=图1, caption=条件变量与结果变量选取, figureFileSmall=yLX/tBtx8Bx8vhr/2t0glg==, figureFileBig=tMJQr9oOjPZQza4EtyPzKA==, tableContent=null), ArticleFig(id=1241069121970958991, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, language=EN, label=Table 1, caption=

The calibration of outcome variables and condition variables in 2021

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变量名称指标完全隶属交叉点完全不隶属
Y公共卫生人力资源密度指数4.831.970.18
X1人口集聚度5.361.920.14
X2人均GDP(万元)11.696.505.08
X3人均工资性收入(元)30 777.316 125.712 597.6
X4地方政府卫生支出(亿元)1 169.79633.70191.61
X5基本公共卫生服务补助资金(万元)371 644194 06237 552
X6每万人机构数(个)0.1930.0940.053
X7每千人床位数(张)0.2790.1980.091
), ArticleFig(id=1241069122067427991, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, language=CN, label=表1, caption=

2021年结果变量与条件变量校准

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名称指标完全隶属交叉点完全不隶属
Y公共卫生人力资源密度指数4.831.970.18
X1人口集聚度5.361.920.14
X2人均GDP(万元)11.696.505.08
X3人均工资性收入(元)30 777.316 125.712 597.6
X4地方政府卫生支出(亿元)1 169.79633.70191.61
X5基本公共卫生服务补助资金(万元)371 644194 06237 552
X6每万人机构数(个)0.1930.0940.053
X7每千人床位数(张)0.2790.1980.091
), ArticleFig(id=1241069122189062817, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, language=EN, label=Table 2, caption=

Results of necessary conditions analysis from 2019 to 2021

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条件变量2019年高公平性(Y)2020年高公平性(Y)2021年高公平性(Y)
一致性覆盖度一致性覆盖度一致性覆盖度
X10.9280.9290.9320.9150.9480.935
X20.7880.7790.7900.7690.8160.764
X30.7320.7580.8110.8150.9730.621
X40.8080.7920.7940.7880.8150.767
X50.6760.6360.6670.6130.6640.616
X60.4550.4520.4360.4310.4380.426
X70.6350.6510.6450.6470.6460.605
), ArticleFig(id=1241069122302309033, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, language=CN, label=表2, caption=

2019—2021年必要条件分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
条件变量2019年高公平性(Y)2020年高公平性(Y)2021年高公平性(Y)
一致性覆盖度一致性覆盖度一致性覆盖度
X10.9280.9290.9320.9150.9480.935
X20.7880.7790.7900.7690.8160.764
X30.7320.7580.8110.8150.9730.621
X40.8080.7920.7940.7880.8150.767
X50.6760.6360.6670.6130.6640.616
X60.4550.4520.4360.4310.4380.426
X70.6350.6510.6450.6470.6460.605
), ArticleFig(id=1241069122440721077, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, language=EN, label=Table 3, caption=

High equity configuration of public health human resources allocation from 2019 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
条件组态2019年2020年2021年
L1L2L3L4L5R1R2R3Z1Z2Z3
X1:人口集聚度
X2:人均GDP
X3:人均工资性收入
X4:地方政府卫生支出
X5:基本公共卫生服务补助资金
X6:每万人机构数
X7:每千人床位数
一致性0.9740.9900.9870.9930.9960.9910.9930.9960.9930.9940.996
原始覆盖度0.4230.3140.3380.2690.1740.4520.2890.1590.4470.4820.174
唯一覆盖度0.2030.0580.0940.0040.0090.2790.1600.0480.3030.3070.016
总覆盖度0.7530.6600.804
总一致性0.9800.9920.993
符合条件省份沪京 津浙豫鄂粤鲁苏鄂湘粤鲁豫 鄂湘冀京浙沪沪津京浙粤鲁豫 鄂湘冀
), ArticleFig(id=1241069123959059130, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, language=CN, label=表3, caption=

2019—2021年公共卫生人力资源配置高公平性组态

, figureFileSmall=null, figureFileBig=null, tableContent=
条件组态2019年2020年2021年
L1L2L3L4L5R1R2R3Z1Z2Z3
X1:人口集聚度
X2:人均GDP
X3:人均工资性收入
X4:地方政府卫生支出
X5:基本公共卫生服务补助资金
X6:每万人机构数
X7:每千人床位数
一致性0.9740.9900.9870.9930.9960.9910.9930.9960.9930.9940.996
原始覆盖度0.4230.3140.3380.2690.1740.4520.2890.1590.4470.4820.174
唯一覆盖度0.2030.0580.0940.0040.0090.2790.1600.0480.3030.3070.016
总覆盖度0.7530.6600.804
总一致性0.9800.9920.993
符合条件省份沪京 津浙豫鄂粤鲁苏鄂湘粤鲁豫 鄂湘冀京浙沪沪津京浙粤鲁豫 鄂湘冀
), ArticleFig(id=1241069124097471169, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, language=EN, label=Table 4, caption=

Robustness test results for increasing consistency thresholds

, figureFileSmall=null, figureFileBig=null, tableContent=
条件组态2019年2020年2021年
L1L2L3L4L5R1R2R3Z1Z2Z3
X1:人口集聚度
X2:人均GDP
X3:人均工资性收入
X4:地方政府卫生支出
X5:基本公共卫生服务补助资金
X6:每万人机构数
X7:每千人床位数
一致性0.9740.9900.9870.9930.9960.9910.9930.9960.9930.9940.996
原始覆盖度0.4230.3140.3380.2690.1740.4520.2890.1590.4470.4820.174
唯一覆盖度0.2030.0580.0940.0040.0090.2790.1600.0480.3030.3070.016
总覆盖度0.7530.6600.804
总一致性0.9800.9920.993
符合条件省份沪京 津浙豫鄂粤鲁苏鄂湘粤鲁豫 鄂湘冀京浙沪沪津京浙粤鲁豫 鄂湘冀
), ArticleFig(id=1241069124193940167, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035819994108301, language=CN, label=表4, caption=

提高一致性数值的稳健性检验结果

, figureFileSmall=null, figureFileBig=null, tableContent=
条件组态2019年2020年2021年
L1L2L3L4L5R1R2R3Z1Z2Z3
X1:人口集聚度
X2:人均GDP
X3:人均工资性收入
X4:地方政府卫生支出
X5:基本公共卫生服务补助资金
X6:每万人机构数
X7:每千人床位数
一致性0.9740.9900.9870.9930.9960.9910.9930.9960.9930.9940.996
原始覆盖度0.4230.3140.3380.2690.1740.4520.2890.1590.4470.4820.174
唯一覆盖度0.2030.0580.0940.0040.0090.2790.1600.0480.3030.3070.016
总覆盖度0.7530.6600.804
总一致性0.9800.9920.993
符合条件省份沪京 津浙豫鄂粤鲁苏鄂湘粤鲁豫 鄂湘冀京浙沪沪津京浙粤鲁豫 鄂湘冀
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基于模糊集定性比较分析的中国公共卫生人力资源配置公平性影响因素与提升路径研究
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陆瑞钊 1, 2 , 黄凌波 1, 2 , 吴雨洁 1, 2 , 冯启明 1, 2 , 黄馨慧 1, 2 , 孙四维 1, 2 , 李贞 1
现代预防医学 | 卫生政策与管理 2024,51(23): 4321-4326
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现代预防医学 | 卫生政策与管理 2024, 51(23): 4321-4326
基于模糊集定性比较分析的中国公共卫生人力资源配置公平性影响因素与提升路径研究
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陆瑞钊1, 2, 黄凌波1, 2, 吴雨洁1, 2, 冯启明1, 2, 黄馨慧1, 2, 孙四维1, 2, 李贞1
作者信息
  • 1.广西医科大学卫生与健康政策研究中心(广西高端智库建设培育单位),广西 南宁 530021
  • 2.广西医科大学信息与管理学院,广西 南宁 530021
  • 陆瑞钊(2001—),男,硕士在读,研究方向:卫生人力资源

通讯作者:

李贞,E-mail:
Research on the influencing factors and improvement paths of equity in the allocation of public health human resources in China based on fuzzy set qualitative comparative analysis
Rui-zhao LU1, 2, Ling-bo HUANG1, 2, Yu-jie WU1, 2, Qi-ming FENG1, 2, Xin-hui HUANG1, 2, Si-wei SUN1, 2, Zhen LI1
Affiliations
  • School of Information and Management, Guangxi Medical University, Nanning, Guangxi 530021, China
出版时间: 2024-12-10 doi: 10.20043/j.cnki.MPM.202405397
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目的

探究我国公共卫生人力资源配置公平性影响因素及提升路径,为加快公共卫生人才队伍建设提供借鉴与参考。

方法

采用集聚度评估2019—2021年全国公共卫生人力资源配置公平性,运用模糊集定性比较分析方法探讨影响其公平性的路径。

结果

2019—2021年公共卫生人力资源配置高公平性组态共有11条,总一致性和总覆盖度分别在0.97(>0.8)和0.66(>0.5)以上,模型解释力较强,人口集聚度作为核心条件出现在所有组态当中。

结论

公共卫生人力资源配置公平虽是多方因素综合作用的结果,但重点方向仍有迹可循,其中人口集聚度是核心因素,机构配置水平和政府卫生支出是重要抓手,机构、个人、社会和政府等多类要素间的协同作用有助于实现公共卫生人力资源配置高公平性。

模糊集定性比较分析  /  卫生人力资源  /  公平性  /  中国
Objective

To explore the influencing factors and improvement paths for the equity of public health human resource allocation in China, providing references for accelerating the development of the public health talent workforce.

Methods

The study assessed the equity of public health human resource allocation in China from 2019 to 2021 through concentration degree evaluation and employed fuzzy set qualitative comparative analysis to investigate the pathways affecting its equity.

Results

There were 11 configurations in the high equity group for public health human resource allocation from 2019 to 2021, with a total consistency and total coverage of 0.97 (>0.8) and 0.66 (>0.5), respectively, indicating a strong explanatory power of the model. Population concentration emerged as a core condition across all configurations.

Conclusion

The equity of public health human resource allocation results from a combination of multiple factors, with identifiable key directions. Among these, population concentration is a core factor, while institutional allocation levels and government health expenditures serve as important leverage points. The synergistic effects among various elements, including institutions, individuals, society, and government, contribute to achieving high equity in public health human resource allocation.

Fuzzy set qualitative comparative analysis  /  Health human resources  /  Equity  /  China
陆瑞钊, 黄凌波, 吴雨洁, 冯启明, 黄馨慧, 孙四维, 李贞. 基于模糊集定性比较分析的中国公共卫生人力资源配置公平性影响因素与提升路径研究. 现代预防医学, 2024 , 51 (23) : 4321 -4326 . DOI: 10.20043/j.cnki.MPM.202405397
Rui-zhao LU, Ling-bo HUANG, Yu-jie WU, Qi-ming FENG, Xin-hui HUANG, Si-wei SUN, Zhen LI. Research on the influencing factors and improvement paths of equity in the allocation of public health human resources in China based on fuzzy set qualitative comparative analysis[J]. Modern Preventive Medicine, 2024 , 51 (23) : 4321 -4326 . DOI: 10.20043/j.cnki.MPM.202405397
公共卫生人力资源配置公平性关系到公共卫生服务的可获得性,对推动我国公共卫生体系建设以及卫生健康事业高质量发展具有重要意义[1]。然而目前我国公共卫生人力资源总供给不足、地区分布不均衡、人才流失严重等问题制约着我国公共卫生事业高质量发展。加快公共卫生人才队伍建设,健全公共卫生服务体系是实现我国卫生健康事业现代化的重要支撑。
公共卫生人力资源配置是一项复杂的系统性工程,涉及面广、制约因素多且机理繁杂。学界普遍认为影响公共卫生人力资源配置公平可分成机构配置、基础设施、薪酬激励水平等内部因素[2-4]和财政支持、个人收入水平、卫生筹资水平、城镇化率、政策倾斜、经济发展等外部因素[5-6]。当下学者主要从公共卫生人力资源分布、配置、供给预测等方面展开研究[7-8],已有研究多在横截面上运用传统的洛伦兹曲线、基尼系数、泰尔指数等方法从单因素角度探究公共卫生人力资源分配的公平性差异[9-10],容易忽视不同要素之间的交互作用以及内外部环境的互动。少有基于纵向数据探讨多因素交互效应对公共卫生人力资源分配公平的影响和从组态视角探究公共卫生人力资源配置的前因变量组合能否充分实现高公平性结果,并对比分析某一条件或组态有无出现占优的情况。因此,本研究拟通过集聚度对2019—2021年全国公共卫生人力资源配置公平性进行评估,采用模糊集定性比较分析法探究影响其公平性路径,从而为推进我国公共卫生人才队伍建设、完善公共卫生服务体系提供借鉴与参考。
本文以我国31个省、直辖市(不含港澳台地区)作为研究对象,数据源自2020—2022年《中国卫生健康统计年鉴》《中国统计年鉴》以及国家财政部官方网站。
卫生资源集聚度(health resource agglomeration degree, HRAD)由学者袁素维[11]在产业集聚度的理论基础上进一步延伸而来,是指一个地区占国家1%土地上汇聚的卫生资源数量所占比例,可进一步细化为对卫生人员集聚度的评价,公式如下:
HRADi代表区域i的医疗资源集聚程度,HRi表示区域i的医疗资源总量,Ai代表某地i的区域面积,HRn表示全国医疗资源总量,An代表全国土地总面积。
模糊集定性比较分析法(fuzzy-set qualitative comparative analysis, fsQCA)近年来在处理中小样本、复杂配置问题等方面引起学者们的重视,逐步成为管理、卫生等领域研究因果关系复杂度的重要研究方法[12]。在fsQCA研究中,条件个数控制在6~8条为宜,从而达到条件数量与案例数量、分析结果简洁性之间的均衡水平[13]
以公共卫生人力资源集聚度作为结果变量,度量全国公共卫生人力资源配置公平性[14]
综合考虑已有研究,结合公共卫生人力资源配置的实际情况,兼顾数据的可获得性、典型性、代表性原则,分别从个人、社会、政府以及公共卫生机构配置等四方面选取条件变量构建指标体系。其中人均工资性收入作为个人层面指标,人口集聚度和人均GDP作为社会经济发展指标,政府卫生支出和基本公共卫生服务补助资金作为政府层面指标,每万人机构数和每千人床位数作为机构层面指标。见图1
采用直接校准法把完全非从属、相互交叉点和完全从属3个锚点分别设置为案例数据的90%、50%和10%分位数,以2021年原始数据校准为例,见表1
将数据录入Excel 2021,整理并计算出各省市公共卫生人力资源集聚度,其次对数据进行校准,最后运用fsQCA4.1软件进行必要条件分析、组态分析及稳健性检验。
当一致性超过0.9,则该条件被视为必要条件。必要条件分析结果显示,2019—2020年X1一致性分别为0.928、0.932,表明高人口集聚度为必要条件;2021年X1、X3一致性分别为0.948、0.973,代表高人口集聚度、高收入水平是必要条件。见表2
本研究将样本个数设为1,原始一致性数值和PRI值分别设为0.8和0.9,输出结果显示,2019—2021年我国公共卫生人力资源配置存在11种高公平性组态,11条组态的一致性都达到0.97以上(>0.8),符合标准要求,解释力较强。进一步将核心条件相同的组态归纳得到3种促进公共卫生人力资源配置公平的组态类型。
组态Z1表示在缺乏财政支持和机构配置不完善情况下,以人口集聚度为核心条件,若有发达的经济水平为辅助条件,就能实现公共卫生人力资源配置公平。此路径中仅有社会层面中的人口集聚度发挥主导作用,故将该组态命名为单核驱动型。
组态L1表示在人口稠密、经济发达且收入高的地区,即使机构配置和补助资金不足,也能实现公共卫生人力资源配置公平;R2表示在人口密集、经济发达且收入高、卫生财政支出高的地区,即使机构配置不足,仍能实现人力资源配置公平。R3以人口密集和机构配置完善为核心条件,即使收入和经济水平不高、缺乏财政支持情况下仍能实现人力资源公平配置。上述路径均涉及社会经济、财政支持、个人收入、机构配置四个层面中的两层,二者如鸟之两翼缺一不可,故将该组态命名为双轮驱动型。
组态L2表示在人口稠密、机构配置完善、政府卫生支出高且补助资金充足的地区,即使区域经济欠发达,仍能实现人力资源配置公平;L3表示在人口稠密、经济发达且收入高、财政及补助资金充足的地区,即使机构配置不足,仍能实现人力资源配置公平;L4表示在人口密集、经济发达和卫生财政支持、机构配置完善且补助资金充足的地区,即使收入不高,也达到了人力资源高公平配置;L5表示在人口稠密、经济水平和收入较高、机构配置完善地区,即使缺少财政支持,也能实现人力资源配置公平;R1表示在人口密集、财政及补助资金充足、机构配置完善的地区,无论经济发展程度如何,也能实现人力资源公平配置;组态Z2、Z3为等价组态,其以人口集聚、政府卫生支出、机构配置完善为核心条件,若有高收入作为辅助条件,同样能达到人力资源配置公平;以上路径均不约而同涉及社会经济、个人收入、财政支持和机构配置四个层面中的三层,犹如三驾马车并驾齐驱影响公共卫生人力资源配置公平性。见表3
fsQCA是一种集合理论,运算中的微小改动而得到的结果并不影响现有的实质性解释,基于此,将一致性数值从0.8调整至0.85,其他条件不变,结果与现有组态解释相同,说明结果具有良好的稳健性。见表4
必要条件分析结果表明,2019—2021年高人口集聚度是公共卫生人力资源配置公平的必要条件,组态结果同样表明人口集聚度是每一路径的核心条件,即地区人口越稠密,公共卫生人力资源配置公平性越高。我国人口分布长期以来主要集中于东部沿海省份,而中西部省份人口密度较为稀疏。究其原因,主要有以下方面:其一,我国东部沿海地影响区经济发展水平高、交通便利、医疗保障和教育体系完善,虹吸了大批中西部地区劳动力集聚。人口密度增加的同时也会刺激居民的卫生健康需求,尤其是对预防、接种、免疫等公共卫生需求,而公共卫生需求缺口的不断扩大则会虹吸大量欠发达地区的公共卫生人员前来就业,造成人口密集区域的公共卫生人力资源分配不合理[15]。其二,由于我国很长一段时间都是以人口拥有量作为衡量资源分配公平的尺度,容易忽视人口流动、地理因素等条件影响[16],致使人口稠密地区拥有明显的人力资源地理分布优势,甚至部分区域资源过度集中(如北上广深),而地广人稀的中西部省份人力资源则较为匮乏,进一步扩大了我国公共卫生人力资源分布差异性。
公共卫生机构配置当中的每千人床位数在2019—2021年众多高公平性组态当中充当核心条件持续发挥主导作用。即机构配置水平越完善,则该地公共卫生人力资源配置公平性越高。据《2022中国卫生健康统计年鉴》数据显示,2021年专业公共卫生机构每千人口床位数较2019年有所增长,表明机构资源配置得到进一步优化和完善,有助于实现人力资源配置公平。此外,R3路径的海南省,即使其余条件都不如其他省,但在高人口密度和完善的机构配置共同作用下仍然实现了公共卫生人力资源公平配置。一方面机构配置水平是衡量各地对公共卫生事业发展重视程度的晴雨表[9],另一方面完善的机构配置按国家相关规定需配齐公共卫生人员,提供了大量优质岗位,有利于吸引更多公共卫生医师前来工作,从而实现公共卫生人才的集聚,有助于该区域实现公共卫生人力资源高公平配置。
政府卫生支出作为核心条件在2019—2021年不同高公平性组态当中持续发挥主导作用。因此,有充分理由表明地方政府卫生支出越高,则该区域实现公共卫生人力资源高公平配置的可能性越大。首先,公共卫生机构属于公益一类事业单位,财政全额拨款是其主要经费来源,地方政府卫生支出水平决定了公共卫生机构发展水平,也对区域整体公共卫生人力资源公平配置产生直接影响。其次,部分资源供应相对较少的地区,通过增加当地政府对卫生健康的财政支持,也具备实现人力资源高公平配置条件。例如L2路径所包含的河南和湖北,即使个人收入和经济发展水平不如东部沿海省份,但在当地政府卫生财政强有力的支援下依旧达到了公共卫生人力资源高公平配置。
公共卫生人力资源高公平配置受到个人、社会、政府、机构四个层面的交互作用。实证表明,在2019—2021年高公平性组态当中,均包含了人口稠密、卫生财政支持、地区经济发达且收入水平高、机构配置完善等多个要素,在公共卫生体系内部和外部环境的两个层面共同作用下,能集聚大量公共卫生人才,从而实现人力资源高公平配置。与此同时,在L4路径所包含的湖北和湖南两省,机构、社会及政府三个层面同时处于高位状态,共同推动了人力资源高公平配置。上述区域人口密度大、经济发展势头强劲、政府重视人民的健康并积极提供财政支持和保障、人民生活富足、公共卫生服务和机构配置完善,此时该区域在积极卫生政策引导下,健康需求旺盛、居民保健消费意愿强、公共卫生服务市场欣欣向荣,助推公共卫生人才柔性流动通道的形成。
鉴于此,对于公共卫生人力资源配置公平性较低的新疆、宁夏、甘肃、黑龙江、内蒙古、吉林、云南等省份,可以从以下几个方面改进资源的配置和使用:第一,结合国家西部大开发与乡村振兴战略,因地制宜大力发展各类产业,创造优质就业岗位,吸引外出人口回流和外地人口流入以提高人口密度。第二,在制定整体区域公共卫生资源规划时,政府应基于现有资源并结合当地人口流动和目标群体实际需求,合理配置公共卫生资源,进一步提升公共卫生服务的可及性,从而促进人力资源配置公平。第三,提高政府卫生支出水平并充分发挥基本公共卫生财政转移支付对公共卫生人才的激励、补贴等方面作用,对各级公共卫生工作者的劳动和技术价值给予应有的尊重,逐步改变欠发达地区人才流失状况[15]。第四,强化个人、社会、政府和机构层面的协同联动作用,树立大健康理念,提高公民健康意识,发挥政策引导作用和加大财政支持力度,积极改善公共卫生机构资源配置水平,释放健康保健消费需求,实现市场对人才的自发调控与吸引。此时内外部各要素之间协同发展最大化发挥合力,最终实现公共卫生人力资源公平合理配置。
  • 广西自然科学基金(2020JJB180002)
  • 广西高等学校千名中青年骨干教师培育计划(2022QGRW015)
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2024年第51卷第23期
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doi: 10.20043/j.cnki.MPM.202405397
  • 接收时间:2024-05-23
  • 首发时间:2026-03-18
  • 出版时间:2024-12-10
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  • 收稿日期:2024-05-23
基金
广西自然科学基金(2020JJB180002)
广西高等学校千名中青年骨干教师培育计划(2022QGRW015)
作者信息
    1.广西医科大学卫生与健康政策研究中心(广西高端智库建设培育单位),广西 南宁 530021
    2.广西医科大学信息与管理学院,广西 南宁 530021

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2种不同金属材料的力学参数

Family
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Number of
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种数
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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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