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Objective

To explore the coordination relationship and spatial pattern of health resource allocation and socioeconomic development in Sichuan Province, to provide references for promoting the high-quality development of health and social economy.

Methods

Entropy method, comprehensive evaluation index, and coupling coordination degree model were used to evaluate the level and coupling coordination degree of health resources and socio-economic development. Hot spot analysis was used to explore the characteristics of spatial agglomeration.

Results

From 2017 to 2021, the development level of health resource allocation in different economic regions of Sichuan Province was in the following order: northwest Sichuan Ecological Demonstration Zone (0.59), Panxi Economic Zone (0.35), Chengdu Plain Economic Zone/Southern Sichuan Economic Zone(0.30), and Northeast Sichuan Economic Zone (0.23). The order of social and economic development level was as the follows:Chengdu Plain Economic Zone (0.25), Panxi Economic Zone (0.16), South Sichuan Economic Zone (0.15), Northeast Sichuan Economic Zone (0.10), and Northwest Sichuan Ecological demonstration Zone (0.08). In the past five years, most of the coupling coordination degree of different economic regions showed an increasing trend. Only the average coupling coordination degree of northeast Sichuan economic zone was less than 0.4, which was in a maladjusted recession, while the average coupling coordination degree of the remaining four economic zones was between 0.4 and 0.5, which was in transition harmony and generally subject to the lag of social and economic development. The level of coupling coordination showed a spatial pattern of“high in the west and low in the east”, and the agglomeration characteristics were mainly “high-high” agglomeration area in western Sichuan and “low-low” agglomeration area in northeastern Sichuan.

Conclusion

There are obvious regional differences in the allocation of health resources and the level of socio-economic development in Sichuan Province. The trend of coupling and coordination between the two systems is gradually improving, but the degree of coordination is not high. In addition, the coupling coordination level has significant spatial characteristics, and the local area shows agglomeration effect.

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目的

探讨四川省卫生资源配置与社会经济发展的协调关系及空间格局,为推进卫生事业与社会经济高质量发展提供参考。

方法

利用熵权法、综合评价指数、耦合协调度模型测评卫生资源与社会经济发展水平及耦合协调度,运用热点分析探究其空间集聚特征。

结果

2017—2021年四川省不同经济区域卫生资源配置发展水平由高到低依次为川西北生态示范区(0.59)、攀西经济区(0.35)、成都平原经济区/川南经济区(0.30)、川东北经济区(0.23),而社会经济发展水平顺位排序为成都平原经济区(0.25)、攀西经济区(0.16)、川南经济区(0.15)、川东北经济区(0.10)、川西北生态示范区(0.08)。五年间不同经济区域的耦合协调度绝大部分呈现增长趋势。仅川东北经济区耦合协调度均值低于0.4,处于失调衰退,余下四大经济区耦合协调度均值介于0.4~0.5,处于过渡调和,且总体均受制于社会经济发展滞后。耦合协调水平呈现“西高东低”的空间格局,集聚特征以川西部“高-高”集聚区与川东北部“低-低”集聚区为主。

结论

四川省卫生资源配置与社会经济发展水平存在明显区域差异,两类系统耦合协调趋势逐步向好,但协调程度不高。此外,耦合协调水平存有显著空间特征,局部区域呈现集聚效应。

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马原,E-mail:
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许靖(1995-),女,硕士,卫生管理师,研究方向:卫生事业管理

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Modern Preventive Medicine, 2020, 47(7): 1231-1234, 1248., articleTitle=Fairness of health resource allocation from the perspective of regional comparison, Sichuan, refAbstract=null)], funds=[Fund(id=1241677627354829567, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, awardId=SWFZ22-Q-48, language=CN, fundingSource=四川省基层卫生事业发展研究中心青年项目(SWFZ22-Q-48), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241677618240606618, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, xref=1., ext=[AuthorCompanyExt(id=1241677618248995226, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, companyId=1241677618240606618, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Leshan People’s Hospital, Leshan, Sichuan 614000, China), AuthorCompanyExt(id=1241677618257383835, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, companyId=1241677618240606618, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.乐山市人民医院,四川 乐山 614000)]), AuthorCompany(id=1241677618366435748, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, xref=2., ext=[AuthorCompanyExt(id=1241677618374824358, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, companyId=1241677618366435748, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川大学华西第二医院,四川 成都 610041)])], figs=[ArticleFig(id=1241677625735828145, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, language=EN, label=Figure 1, caption=Health resource allocation and socio-economic development index in different economic regions of Sichuan Province, figureFileSmall=Jg5OceH/rGWjO2mHCUF4Jw==, figureFileBig=H+0qnUNBygfK0azFn28gBg==, tableContent=null), ArticleFig(id=1241677625941349050, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, language=CN, label=图1, caption=四川省不同经济区域卫生资源配置与社会经济发展指数

注:A表示卫生资源配置发展水平;B表示社会经济发展水平。

, figureFileSmall=Jg5OceH/rGWjO2mHCUF4Jw==, figureFileBig=H+0qnUNBygfK0azFn28gBg==, tableContent=null), ArticleFig(id=1241677626054595263, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, language=EN, label=Figure 2, caption=Coupling coordination degree of health resource allocation and socio-economic development in different economic regions of Sichuan Province, figureFileSmall=GC5FHRLLlOF/19S6do6gMw==, figureFileBig=2LmU/riepDT0cfkYsixDCg==, tableContent=null), ArticleFig(id=1241677626172035782, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, language=CN, label=图2, caption=四川省不同经济区域卫生资源配置与社会经济发展耦合协调度, figureFileSmall=GC5FHRLLlOF/19S6do6gMw==, figureFileBig=2LmU/riepDT0cfkYsixDCg==, tableContent=null), ArticleFig(id=1241677626281087693, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, language=EN, label=Figure 3, caption=Distribution and hot spot analysis of coupling coordination degree between health resource allocation and social and economic development in Sichuan Province in 2021, figureFileSmall=uD2fHVksMd2BO/rIMGI1DA==, figureFileBig=cfNwRmaRRaQgdYs7SJLkWg==, tableContent=null), ArticleFig(id=1241677626398528207, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, language=CN, label=图3, caption=2021年四川省卫生资源配置与社会经济发展耦合协调度分布及热点分析

注:底图源于国家地理信息公共服务平台,审图号GS(2019)3333号

, figureFileSmall=uD2fHVksMd2BO/rIMGI1DA==, figureFileBig=cfNwRmaRRaQgdYs7SJLkWg==, tableContent=null), ArticleFig(id=1241677626520163030, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, language=EN, label=Table 1, caption=

Weights of health resources and socioeconomic indicators in Sichuan Province

, figureFileSmall=null, figureFileBig=null, tableContent=
年份(年)卫生资源社会经济
医疗机构数医疗机构床位数执业(助理)医师数注册护士数财政拨款收入地区生产总值地方财政收入城镇化率第三产业产值占GDP比重城镇居民人均可支配收入人均地区生产总值
20170.144 00.086 70.145 10.158 00.466 20.275 00.390 50.050 20.061 30.141 90.081 1
20180.180 30.093 60.150 90.182 60.392 50.279 20.375 30.050 40.080 60.129 40.085 2
20190.207 20.095 60.187 30.180 20.329 80.284 40.381 40.051 40.079 80.117 30.085 7
20200.218 70.097 80.156 40.144 30.382 80.300 30.386 80.051 70.082 70.100 00.078 6
20210.219 50.082 10.145 40.108 30.444 70.311 60.392 70.051 00.082 20.094 60.068 0
), ArticleFig(id=1241677626645992157, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, language=CN, label=表1, caption=

四川省卫生资源与社会经济评价指标权重

, figureFileSmall=null, figureFileBig=null, tableContent=
年份(年)卫生资源社会经济
医疗机构数医疗机构床位数执业(助理)医师数注册护士数财政拨款收入地区生产总值地方财政收入城镇化率第三产业产值占GDP比重城镇居民人均可支配收入人均地区生产总值
20170.144 00.086 70.145 10.158 00.466 20.275 00.390 50.050 20.061 30.141 90.081 1
20180.180 30.093 60.150 90.182 60.392 50.279 20.375 30.050 40.080 60.129 40.085 2
20190.207 20.095 60.187 30.180 20.329 80.284 40.381 40.051 40.079 80.117 30.085 7
20200.218 70.097 80.156 40.144 30.382 80.300 30.386 80.051 70.082 70.100 00.078 6
20210.219 50.082 10.145 40.108 30.444 70.311 60.392 70.051 00.082 20.094 60.068 0
), ArticleFig(id=1241677626851513064, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, language=EN, label=Table 2, caption=

Coupling coordination relationship between health resource allocation and socio-economic development in different regions of Sichuan Province in 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
地区卫生资源发展指数社会经济发展指数耦合协调度协调等级协调类型
成都平原经济区
成都市0.411.000.80中级协调协调发展型
德阳市0.210.190.44濒临失调过渡调和型
绵阳市0.260.210.48濒临失调过渡调和型
遂宁市0.270.110.42濒临失调过渡调和型
乐山市0.250.170.45濒临失调过渡调和型
雅安市0.540.130.51勉强协调过渡调和型
眉山市0.180.150.41濒临失调过渡调和型
资阳市0.280.100.41濒临失调过渡调和型
平均值0.300.260.49濒临失调过渡调和型
川南经济区
自贡市0.470.150.51勉强协调过渡调和型
泸州市0.300.160.47濒临失调过渡调和型
内江市0.290.140.45濒临失调过渡调和型
宜宾市0.260.200.48濒临失调过渡调和型
平均值0.330.160.48濒临失调过渡调和型
川东北经济区
南充市0.270.130.44濒临失调过渡调和型
广元市0.430.080.43濒临失调过渡调和型
巴中市0.260.070.37轻度失调失调衰退型
达州市0.170.130.39轻度失调失调衰退型
广安市0.100.120.33轻度失调失调衰退型
平均值0.250.110.39轻度失调失调衰退型
攀西经济区
攀枝花市0.400.200.53勉强协调过渡调和型
凉山州0.250.100.39轻度失调失调衰退型
平均值0.320.150.46濒临失调过渡调和型
川西北生态示范区
甘孜州0.540.080.46濒临失调过渡调和型
阿坝州0.780.110.54勉强协调过渡调和型
平均值0.660.100.50濒临失调过渡调和型
), ArticleFig(id=1241677627061228273, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522776931103735, language=CN, label=表2, caption=

2021年四川省不同地区卫生资源配置与社会经济发展耦合协调关系

, figureFileSmall=null, figureFileBig=null, tableContent=
地区卫生资源发展指数社会经济发展指数耦合协调度协调等级协调类型
成都平原经济区
成都市0.411.000.80中级协调协调发展型
德阳市0.210.190.44濒临失调过渡调和型
绵阳市0.260.210.48濒临失调过渡调和型
遂宁市0.270.110.42濒临失调过渡调和型
乐山市0.250.170.45濒临失调过渡调和型
雅安市0.540.130.51勉强协调过渡调和型
眉山市0.180.150.41濒临失调过渡调和型
资阳市0.280.100.41濒临失调过渡调和型
平均值0.300.260.49濒临失调过渡调和型
川南经济区
自贡市0.470.150.51勉强协调过渡调和型
泸州市0.300.160.47濒临失调过渡调和型
内江市0.290.140.45濒临失调过渡调和型
宜宾市0.260.200.48濒临失调过渡调和型
平均值0.330.160.48濒临失调过渡调和型
川东北经济区
南充市0.270.130.44濒临失调过渡调和型
广元市0.430.080.43濒临失调过渡调和型
巴中市0.260.070.37轻度失调失调衰退型
达州市0.170.130.39轻度失调失调衰退型
广安市0.100.120.33轻度失调失调衰退型
平均值0.250.110.39轻度失调失调衰退型
攀西经济区
攀枝花市0.400.200.53勉强协调过渡调和型
凉山州0.250.100.39轻度失调失调衰退型
平均值0.320.150.46濒临失调过渡调和型
川西北生态示范区
甘孜州0.540.080.46濒临失调过渡调和型
阿坝州0.780.110.54勉强协调过渡调和型
平均值0.660.100.50濒临失调过渡调和型
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基于系统耦合视角的四川省卫生资源配置与社会经济发展协调状况研究
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许靖 1 , 余欣 1 , 马洪涛 1 , 万蓓欣 1 , 刘洁星 1 , 马原 2
现代预防医学 | 卫生政策与管理 2024,51(1): 93-98
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现代预防医学 | 卫生政策与管理 2024, 51(1): 93-98
基于系统耦合视角的四川省卫生资源配置与社会经济发展协调状况研究
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许靖1, 余欣1, 马洪涛1, 万蓓欣1, 刘洁星1, 马原2
作者信息
  • 1.乐山市人民医院,四川 乐山 614000
  • 2.四川大学华西第二医院,四川 成都 610041
  • 许靖(1995-),女,硕士,卫生管理师,研究方向:卫生事业管理

通讯作者:

马原,E-mail:
Study on the coordination of health resource allocation and socio-economic development in Sichuan Province from the perspective of system coupling
Jing XU1, Xin YU1, Hong-tao MA1, Bei-xin WAN1, Jie-xing LIU1, Yuan MA2
Affiliations
  • Leshan People’s Hospital, Leshan, Sichuan 614000, China
出版时间: 2024-01-10 doi: 10.20043/j.cnki.MPM.202306201
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目的

探讨四川省卫生资源配置与社会经济发展的协调关系及空间格局,为推进卫生事业与社会经济高质量发展提供参考。

方法

利用熵权法、综合评价指数、耦合协调度模型测评卫生资源与社会经济发展水平及耦合协调度,运用热点分析探究其空间集聚特征。

结果

2017—2021年四川省不同经济区域卫生资源配置发展水平由高到低依次为川西北生态示范区(0.59)、攀西经济区(0.35)、成都平原经济区/川南经济区(0.30)、川东北经济区(0.23),而社会经济发展水平顺位排序为成都平原经济区(0.25)、攀西经济区(0.16)、川南经济区(0.15)、川东北经济区(0.10)、川西北生态示范区(0.08)。五年间不同经济区域的耦合协调度绝大部分呈现增长趋势。仅川东北经济区耦合协调度均值低于0.4,处于失调衰退,余下四大经济区耦合协调度均值介于0.4~0.5,处于过渡调和,且总体均受制于社会经济发展滞后。耦合协调水平呈现“西高东低”的空间格局,集聚特征以川西部“高-高”集聚区与川东北部“低-低”集聚区为主。

结论

四川省卫生资源配置与社会经济发展水平存在明显区域差异,两类系统耦合协调趋势逐步向好,但协调程度不高。此外,耦合协调水平存有显著空间特征,局部区域呈现集聚效应。

卫生资源配置  /  社会经济发展  /  耦合协调度  /  空间格局  /  四川
Objective

To explore the coordination relationship and spatial pattern of health resource allocation and socioeconomic development in Sichuan Province, to provide references for promoting the high-quality development of health and social economy.

Methods

Entropy method, comprehensive evaluation index, and coupling coordination degree model were used to evaluate the level and coupling coordination degree of health resources and socio-economic development. Hot spot analysis was used to explore the characteristics of spatial agglomeration.

Results

From 2017 to 2021, the development level of health resource allocation in different economic regions of Sichuan Province was in the following order: northwest Sichuan Ecological Demonstration Zone (0.59), Panxi Economic Zone (0.35), Chengdu Plain Economic Zone/Southern Sichuan Economic Zone(0.30), and Northeast Sichuan Economic Zone (0.23). The order of social and economic development level was as the follows:Chengdu Plain Economic Zone (0.25), Panxi Economic Zone (0.16), South Sichuan Economic Zone (0.15), Northeast Sichuan Economic Zone (0.10), and Northwest Sichuan Ecological demonstration Zone (0.08). In the past five years, most of the coupling coordination degree of different economic regions showed an increasing trend. Only the average coupling coordination degree of northeast Sichuan economic zone was less than 0.4, which was in a maladjusted recession, while the average coupling coordination degree of the remaining four economic zones was between 0.4 and 0.5, which was in transition harmony and generally subject to the lag of social and economic development. The level of coupling coordination showed a spatial pattern of“high in the west and low in the east”, and the agglomeration characteristics were mainly “high-high” agglomeration area in western Sichuan and “low-low” agglomeration area in northeastern Sichuan.

Conclusion

There are obvious regional differences in the allocation of health resources and the level of socio-economic development in Sichuan Province. The trend of coupling and coordination between the two systems is gradually improving, but the degree of coordination is not high. In addition, the coupling coordination level has significant spatial characteristics, and the local area shows agglomeration effect.

Health resource allocation  /  Social and economic development  /  Coupling coordination degree  /  Spatial pattern  /  Sichuan
许靖, 余欣, 马洪涛, 万蓓欣, 刘洁星, 马原. 基于系统耦合视角的四川省卫生资源配置与社会经济发展协调状况研究. 现代预防医学, 2024 , 51 (1) : 93 -98 . DOI: 10.20043/j.cnki.MPM.202306201
Jing XU, Xin YU, Hong-tao MA, Bei-xin WAN, Jie-xing LIU, Yuan MA. Study on the coordination of health resource allocation and socio-economic development in Sichuan Province from the perspective of system coupling[J]. Modern Preventive Medicine, 2024 , 51 (1) : 93 -98 . DOI: 10.20043/j.cnki.MPM.202306201
卫生资源数量与质量是衡量一个国家或地区经济水平及卫生事业发展的重要评估指标[1]。当前我国社会经济已由高速增长阶段迈向高质量发展阶段,社会发展转型也带来新的人群健康问题,那么合理配置卫生资源满足居民日益增长的健康需求显得尤为重要。事实上,卫生资源配置与社会经济发展存在一定耦合关联,两者相辅相成,相互影响[2]。一方面,社会经济高质量发展是卫生资源投入的经济基础,通过卫生资源投入可为居民提供全方位全周期的健康服务,不断提升居民健康水平。另一方面,居民健康水平的改善可进一步为社会经济提供充足人力保障,以持久的动力助推国民经济可持续发展。因此,协调卫生资源配置与社会经济发展之间的关系,对于完善卫生服务体系,推进健康中国建设,促进社会经济高质量发展意义重大。
已有研究多以探讨国家层面卫生资源配置与社会经济发展的协调关系[2-4],亦或卫生资源供给与需求的耦合协调[5-6],较少针对地区层面展开分析。基于此,本研究从系统耦合视角出发,利用耦合协调度模型分析四川省卫生资源配置与地区经济的耦合协调发展关系,明晰相对发展状况,以期为政策优化提供决策参考。
研究以四川省21个市(州)为分析对象,按照经济区域划分标准将其划分为成都平原经济区、川南经济区、川东北经济区、攀西经济区、川西北生态示范区五个区域。纳入的卫生资源配置与社会经济发展指标数据源自2017—2021年《四川卫生健康统计年鉴》、2018—2022年《四川统计年鉴》。
综合考虑指标选取的科学性、整体性、层次性、数据可得性等原则,借鉴既往相关研究[4,7-8],通过专家咨询及系统分析等方式,最终从人力、财力、物力三方面选取医疗机构数、医疗机构床位数、执业(助理)医师数、注册护士数、财政拨款收入作为卫生资源配置评价指标;为较好衡量经济发展水平,从经济规模、经济结构、经济效益三个方面纳入地区生产总值、地方财政收入、城镇化率、第三产业产值占GDP比重、城镇居民人均可支配收入、人均地区生产总值作为社会经济发展评价指标。
因评价指标对目标对象的作用及影响程度具有差异,故需根据指标重要性程度对其进行权重赋值。作为客观赋权的重要方法,熵权法可克服主观赋权的主观与臆断等问题,具有简便高效等优点,可使得评价结果更具科学性[1]。因此,本研究采用熵权法确定评价指标权重。计算步骤参见李丽清等[4]的研究。
基于评价指标标准化数据及熵权值,运用线性加权法分别计算卫生资源配置与社会经济发展水平的综合评价指数[9]。计算公式为:
式(1)中,xi表示地区i的综合评价指数,ωj为第j项评价指标的的权重为地区ij项评价指标的标准化数据,n表示评价指标数。评价指数越大表示其发展水平越高。
利用耦合协调度模型分析卫生资源与社会经济两类系统内部要素之间相互作用、彼此影响的程度,综合反映系统发展的协调关系。耦合协调度计算公式为:
式(2)~式(4)中,D表示耦合协调度,取值范围为[0, 1];C为耦合度,取值范围为[0, 1],取值越大提示卫生资源配置与社会经济的关联程度越大,x1x2分别释义卫生资源配置与社会经济发展两类系统的综合评价指数;T为卫生资源配置与社会经济发展的整体综合评价指数,αβ分别表示两类系统的贡献系数,本研究认为两大系统同等重要,故令α=β=0.05。参考耦合协调度的相关研究[4],对协调类型与耦合协调等级进行分类,见文献评价标准。
热点分析(Getis-Ord Gi*)可以在空间上显示具有统计学意义的热点(高值聚类)与冷点(低值聚类)区域,反映地区间卫生资源配置与社会经济发展耦合协调的空间依赖性及异质性[10-11]。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,提示该地区不存在具有统计学意义的空间聚类[12]。本研究利用热点分析探讨卫生资源配置与社会经济发展两大系统耦合协调的空间影响。计算公式为:
式(5)中,Di表示地区i的耦合协调度,m为地区数,Wij为空间权重矩阵,空间相邻取值为1,不相邻取值为0。
表1呈现了2017—2021年四川省卫生资源配置与社会经济发展评价指标权重。总体上,医疗机构数与财政拨款收入对卫生资源配置影响较大,而地区生产总值与地方财政收入在社会经济发展中起主要导向作用。
综合评价指数根据式(1)计算。2017—2021年成都平原经济区卫生资源配置发展水平由0.26升至0.30,川南经济区由0.24升至0.33,川东北经济区由0.18升至0.25,攀西经济区由0.33波动降至0.32,川西北生态示范区由0.61波动升至0.66。于平均发展水平而言,川西北生态示范区(0.59)>攀西经济区(0.35)>成都平原经济区(0.30)=川南经济区(0.30)>川东北经济区(0.23)。社会经济发展水平方面,2017—2021年成都平原经济区由0.25升至0.26,川南经济区由0.14升至0.16,川东北经济区由0.09升至0.11,攀西经济区由0.16降至0.15,川西北生态示范区由0.06波动升至0.10。观之其平均发展水平,成都平原经济区(0.25)>攀西经济区(0.16)>川南经济区(0.15)>川东北经济区(0.10)>川西北生态示范区(0.08)。见图1
耦合协调度根据式(2)~式(4)计算。五年间除攀西经济区外,余下四大经济区的耦合协调度均有所增长,耦合协调度平均值分别为0.49(成都平原经济区)、0.46(川南经济区)、0.38(川东北经济区)、0.47(攀西经济区)、0.46(川西北生态示范区)。其中成都平原经济区、川南经济区、攀西经济区与川西北生态示范区均属过渡调和型,且社会经济发展水平低于卫生资源配置发展水平,为经济发展滞后型协调。相较之下,川东北经济区处于失调衰退型,但亦归属于经济发展滞后型协调。见图2
2021年阿坝州(最高)卫生资源配置发展水平约为广安市(最低)的7.9倍。五大经济区域中卫生资源配置发展水平最高分别为雅安市、自贡市、广元市、攀枝花市、阿坝州,最低的依次是眉山市、宜宾市、广安市、凉山州、甘孜州。社会经济发展水平方面,较之最低的巴中市,成都市约是其经济发展水平的14.3倍。五大经济区域中社会经济发展水平最高的依次是成都市、宜宾市、南充市/达州市、攀枝花市、阿坝州,最低的依次为资阳市、内江市、巴中市、凉山州、甘孜州。见表2
观之耦合协调度,成都市属协调发展型,巴中市、达州市、广安市、凉山州处于失调衰退,余下16个市(州)均属过渡调和型。此外,对比卫生资源配置与社会经济发展水平,仅成都市与广安市归属于资源配置滞后型协调,其他19个市(州)均属经济发展滞后型协调。见表2
2021年四川省卫生资源配置与社会经济发展耦合协调度呈现“西高东低”的空间分布特征,地区差异较为显著。值得注意的是,甘孜州与阿坝州社会经济发展水平较低,但其卫生资源配置发展水平却较高,这可能与政府大力扶持民族地区卫生健康事业有关。热点分析根据式(5)计算。结果显示阿坝州处于热点区域,与其周围的甘孜州、雅安市、成都市、德阳市、绵阳市形成“高-高”集聚效应,而南充市与达州市则处于冷点区域,与其周围的广元市、巴中市、广安市、遂宁市形成“低-低”集聚效应。余下不显著区域则表明与其相邻地区不存在空间相关性。见图3
2017—2021年四川省不同经济区域卫生资源配置与社会经济平均发展水平差异较为明显。卫生资源配置发展水平表现为川西北生态示范区>攀西经济区>成都平原经济区=川南经济区>川东北经济区,其中居首位的川西北生态示范区已达川东北经济区发展水平的2.6倍;而社会经济发展水平由高到低依次为成都平原经济区、攀西经济区、川南经济区、川东北经济区、川西北生态示范区,相较于居末端的川西北生态示范区,成都平原经济区发展水平已超其三倍有余。此外,不同经济区域内部各市(州)的两类系统亦是存有发展差异。一般而言,地区卫生资源配置量与社会经济水平呈现同向发展。本研究中川西北生态示范区社会经济水平较低,但卫生资源配置发展水平却居首位,与社会经济水平排列第一的成都平原经济区形成反向对比。究其原因,主要源自川西北生态示范区仅含甘孜州与阿坝州,属典型民族地区,地广人稀、交通不便、社会经济发展水平不高,故政府对其卫生健康事业扶持力度较大,财政补助高于成都平原等经济水平较高地区。为平衡区域发展差异,建议统筹考虑全局及重点区域,综合人口数量与经济水平,实施差异化的卫生资源配置政策,科学有效编制区域医疗卫生发展规划,构建与社会经济发展水平相适应,且有效、经济、公平的卫生服务体系[13]
综合经济区域卫生资源配置与社会经济发展耦合协调来看,五年间成都平原经济区、川南经济区、川东北经济区与川西北生态示范区的耦合协调度均呈增长趋势,发展态势较为良好,攀西经济区耦合协调度虽有小幅下降,但仍居五大经济区域前列。研究结果提示四川省卫生资源配置与社会经济发展的良性互动机制正逐步形成,有利于实现卫生健康事业与社会经济的高质量发展,满足居民日益增长的健康服务需求。尽管如此,两类系统的协调程度却不高,总体受制于社会经济发展滞后。成都平原经济区、川南经济区、攀西经济区与川西北生态示范区的耦合协调度均值介于0.4~0.5,属于过渡调和型,濒临失调,而川东北经济区更是低于0.4,处于失调衰退。不同经济区域内部市(州)也不容乐观,仅成都市处于协调发展,4个市(州)处于失调衰退,余下16个市(州)则处于过渡调和,这与李丽清[4]研究全国基层卫生资源配置与社会经济发展耦合协调关系的结论较为类似。遂建议重点关注川东北经济区等经济发展水平不高区域,政府应积极探索适宜于本地区的经济发展道路,多措并举推动经济层级持续提升,从而增加卫生资源配置投入,促进两类系统协调发展[14]。当然,另一方面也需考虑卫生资源配置效率,避免卫生资源不合理使用,合理调整卫生资源增量与存量,增强抵抗外界环境变化引起健康风险的能力[2]
四川省卫生资源配置与社会经济发展耦合协调水平呈现“西高东低”的空间格局,地区发展不平衡问题较为突出,局部区域存在空间相关性,呈现一定集聚效应,空间集聚特征以川西部“高-高”集聚区与川东北部“低-低”集聚区为主。研究结果提示卫生资源配置与社会经济发展耦合协调水平高的地区会对其邻近地区产生正向辐射影响,从而带动周边地区协调发展,反之则因自身协调水平有限,在空间作用上对邻近地区的拉动作用相对较小。为缩小地区间发展差异,建议耦合协调水平较高地区应积极发挥空间辐射作用,利用远程医疗等方式加强地区之间的卫生资源合作交流,建立区域资源共享机制,实现互联互通[15]。其次,针对卫生资源配置不足地区,可考虑借鉴“分级诊疗”模式,打破区域限制,实行邻近地区的横向分地区诊疗,满足居民的健康需求[5]。再者,社会经济水平较低地区也可依据本地实际情况,学习相关发展经验,持续提升软硬实力,为卫生资源配置提供良好经济基础。此外,进一步完善国家财政横向转移支付政策,由经济雄厚地区向经济薄弱地区转移财政资金,以对口帮扶形势助力提升均等化发展程度[1],弥合区域间两类系统耦合协调水平差异。
  • 四川省基层卫生事业发展研究中心青年项目(SWFZ22-Q-48)
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2024年第51卷第1期
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doi: 10.20043/j.cnki.MPM.202306201
  • 接收时间:2023-06-11
  • 首发时间:2026-03-19
  • 出版时间:2024-01-10
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  • 收稿日期:2023-06-11
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四川省基层卫生事业发展研究中心青年项目(SWFZ22-Q-48)
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    1.乐山市人民医院,四川 乐山 614000
    2.四川大学华西第二医院,四川 成都 610041

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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
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