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Article(id=1241676527608328663, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202405022, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1714579200000, receivedDateStr=2024-05-02, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773968353416, onlineDateStr=2026-03-20, pubDate=1731168000000, pubDateStr=2024-11-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773968353416, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773968353416, creator=13701087609, updateTime=1773968353416, updator=13701087609, issue=Issue{id=1241676522256388920, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='21', pageStart='3841', pageEnd='4032', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773968352140, creator=13701087609, updateTime=1773968629818, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241677686985249701, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241677686985249702, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3936, endPage=3940, ext={EN=ArticleExt(id=1241676528010981883, articleId=1241676527608328663, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of the coupling coordination and spatial characteristics between the construction achievements of the tight-knit county medical community pilot areas and economic development levels in Guangxi, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the coupling coordination relationship between the construction achievements of the 39 tight-knit county medical community pilot counties in Guangxi and the regional economic development levels in 2022.

Methods

The coupling coordination degree model was used to analyze the coupling coordination degree of the two systems. Moran I index was employed to conduct spatial correlation analysis of the coupling coordination degree.

Results

Among the pilot counties, five counties (12.82%) exhibited a moderate coordination type between the construction achievements and regional economic development levels; 21 counties (53.85%) were in a barely coordinated state; and 13 counties (33.33%) showed moderate disorder.The global Moran I index was 0.542.

Conclusion

The coupling coordination degree of the two systems needs improvement; the achievements of the medical community construction are generally ahead of the regional economic development levels; there are regional disparities in coupling coordination degree, and mutual cooperation among the pilot counties in advancing the medical community construction is weak. It is recommended to strengthen cooperation and communication, promote high-quality regional economic development, and facilitate the rational allocation of quality medical and health resources.

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目的

分析2022年广西39个紧密型县域医共体试点县建设成效和区域经济发展水平两系统的耦合协调关系。

方法

运用耦合协调度模型分析两系统的耦合协调度；利用Moran I指数对耦合协调度进行空间相关性分析。

结果

紧密型县域医共体建设成效与区域经济发展水平耦合协调类型为中度协调的试点县有5个，占12.82%；勉强协调的有21个，占53.85%；中度失调有13个，占33.33%；全局Moran I指数为0.542。

结论

两系统耦合协调度有待提高；医共体建设成效整体超前于区域经济发展水平；耦合协调度存在地区差异，各试点县在推进医共体建设方面相互合作性不强。建议要加强合作交流，推进区域经济高质量发展，促进优质医疗卫生资源合理配置。

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冯俊，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=smLBb5HfpjO4D2UuFG63pQ==, magXml=X0o+6Rt7hJtuePk5b5hkgA==, pdfUrl=null, pdf=6IlVF+deGqDK4iXSOJ++Jg==, pdfFileSize=620937, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=5yRnHpP0bKchCGdxg4FU+A==, mapNumber=null, authorCompany=null, fund=null, authors=

张兴隆（1997—），男，硕士在读，研究方向：卫生事业管理

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张兴隆（1997—），男，硕士在读，研究方向：卫生事业管理

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张兴隆（1997—），男，硕士在读，研究方向：卫生事业管理

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journalId=1227665162245664772, articleId=1241676527608328663, language=CN, orderNo=2, keyword=成效), Keyword(id=1241821867158340367, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=CN, orderNo=3, keyword=经济水平), Keyword(id=1241821867305141014, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=CN, orderNo=4, keyword=耦合协调), Keyword(id=1241821867447747358, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=CN, orderNo=5, keyword=空间自相关)], refs=[Reference(id=1241821871935652804, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, doi=null, pmid=null, pmcid=null, year=2023, volume=26, issue=10, pageStart=1212, pageEnd=1217, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=孟业清, 李思思, 秦江梅, journalName=中国全科医学, refType=null, 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Chinese Health Economics, 2022, 41(3): 40-45.(In Chinese), articleTitle=Spatial pattern and evolution trend analysis of health resource allocation and regional economic synergistic development based on coupling coordination theory, refAbstract=null), Reference(id=1241821880047435833, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, doi=null, pmid=null, pmcid=null, year=2021, volume=24, issue=22, pageStart=2777, pageEnd=2784, url=null, language=null, rfNumber=[17], rfOrder=32, authorNames=李丽清, 周绪, 赵玉兰, journalName=中国全科医学, refType=null, unstructuredReference=李丽清，周绪，赵玉兰，等.我国东中西部地区基层医疗资源配置与经济发展耦合协调关系研究[J].中国全科医学，2021，24（22）：2777-2784., articleTitle=我国东中西部地区基层医疗资源配置与经济发展耦合协调关系研究, refAbstract=null), Reference(id=1241821880118739003, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, doi=null, pmid=null, pmcid=null, year=2021, volume=24, issue=22, pageStart=2777, pageEnd=2784, url=null, language=null, rfNumber=[17], rfOrder=33, authorNames=Li LQ, Zhou X, Zhao YL, journalName=Chinese General Practice, refType=null, unstructuredReference=Li LQ, Zhou X, Zhao YL, et al. Degree of coordination between primary care resource allocation and economic development in eastern, central and western China[J]. Chinese General Practice, 2021, 24(22): 2777-2784.(In Chinese), articleTitle=Degree of coordination between primary care resource allocation and economic development in eastern, central and western China, refAbstract=null)], funds=[Fund(id=1241821871663023031, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, awardId=GXZC2023-C3-001424-GTZX, language=CN, fundingSource=2023年度广西特色新型智库联盟重大专题研究项目(GXZC2023-C3-001424-GTZX), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241821858866201104, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, xref=1., ext=[AuthorCompanyExt(id=1241821858874589714, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, companyId=1241821858866201104, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Research Center for Health and Health Policy, Guangxi Medical University (A Unit for the Cultivation of High-end Think Tanks), Nanning, Guangxi 530021, China), AuthorCompanyExt(id=1241821858899755539, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, companyId=1241821858866201104, 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=1241821859021390364, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, xref=2., ext=[AuthorCompanyExt(id=1241821859029778975, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, companyId=1241821859021390364, 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=1241821867741348658, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=EN, label=Table 1, caption=

Coupling stage

, figureFileSmall=null, figureFileBig=null, tableContent=
耦合阶段耦合度两系统发展特征
无关状态C=0无序发展状态
低水平耦合0<C≤0.3相互作用不强但有一定联系
颉颃0.3<C≤0.5具有一定相关性
磨合0.5<C≤0.8联系较为紧密
高水平耦合0.8<C<1有较强的相互作用
良性共振耦合C=1有序发展状态
), ArticleFig(id=1241821867896537917, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=CN, label=表1, caption=

耦合度阶段

, figureFileSmall=null, figureFileBig=null, tableContent=
耦合阶段耦合度两系统发展特征
无关状态C=0无序发展状态
低水平耦合0<C≤0.3相互作用不强但有一定联系
颉颃0.3<C≤0.5具有一定相关性
磨合0.5<C≤0.8联系较为紧密
高水平耦合0.8<C<1有较强的相互作用
良性共振耦合C=1有序发展状态
), ArticleFig(id=1241821868034949958, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=EN, label=Table 2, caption=

Coupling coordination types

, figureFileSmall=null, figureFileBig=null, tableContent=
类型D值范围
良好协调>0.80～1.00
中度协调>0.60～0.80
勉强协调>0.40～0.60
中度失调>0.20～0.40
严重失调>0.00～0.20
), ArticleFig(id=1241821868194333518, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=CN, label=表2, caption=

耦合协调类型

, figureFileSmall=null, figureFileBig=null, tableContent=
类型D值范围
良好协调>0.80～1.00
中度协调>0.60～0.80
勉强协调>0.40～0.60
中度失调>0.20～0.40
严重失调>0.00～0.20
), ArticleFig(id=1241821868336939860, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=EN, label=Table 3, caption=

Evaluation index system and weights for the effectiveness and regional economic development level of tight county medical community construction

, figureFileSmall=null, figureFileBig=null, tableContent=
一级指标二级指标三级指标权重指标性质
A医共体建设成效就医格局A1县域内住院人次占比（%）0.015正向
A2县域就诊率（%）0.006正向
A3县域内基层医疗卫生机构门急诊占比（%）0.025正向
A4县域内基层医疗卫生机构中医药门急诊占比（%）0.056正向
A5牵头医院下转患者数量占比（%）0.127正向
A6慢病患者基层医疗卫生机构管理率（%）0.021正向
A7基层医疗卫生机构人均收入与牵头医院人均收入的比值0.027正向
服务能力A8牵头医院是否达到县级综合医院或中医医院综合能力推荐标准占比（%）0.160正向
A9牵头医院出院患者三四级手术比例（%）0.010正向
A10区域内万人口全科医生数（1/万）0.101正向
A11牵头医院帮助基层开展新技术、新项目的数量（个）0.108正向
A12“优质服务基层行”活动达到基本标准和推荐标准的机构数量（个）0.052正向
A13国家基本公共卫生服务项目实施情况（百分制）0.008正向
资源利用A14牵头医院医疗服务收入占医疗收入的比例（%）0.031正向
A15基层医疗卫生机构医疗服务收入占医疗收入的比例（%）0.018正向
A16基层医疗卫生机构医师日均担负诊疗人次0.030正向
A17基层医疗卫生机构床位使用率（%）0.022正向
A18牵头医院人员经费占业务支出比例（%）0.010正向
A19基层医疗卫生机构财政补助收入占总收入的比例（%）0.034正向
医保效能A20医保基金县域内支出率（不含药店）（%）0.018正向
A21县域内基层医疗卫生机构医保基金占比（%）0.043正向
A22医保考核结果（百分制）0.011正向
A23县域门诊次均费用（元）0.012负向
A24参保人员住院次均费用（元）0.020负向
A25住院费用实际报销比（%）0.016正向
A26参保人员年住院率（%）0.020负向
B经济发展水平经济总量B1地区生产总值（亿元）0.115正向
B2社会消费品零售总额（亿元）0.104正向
B3一般公共预算收入(亿元)0.181正向
经济结构B4第二产业增加值（亿元）0.190正向
B5第三产业增加值（亿元）0.099正向
经济效益B6人均地区生产总值（元）0.246正向
B7人均可支配收入（元）0.064正向
), ArticleFig(id=1241821868479546203, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=CN, label=表3, caption=

紧密型县域医共体建设成效与区域经济发展水平评价指标体系及权重

, figureFileSmall=null, figureFileBig=null, tableContent=
一级指标二级指标三级指标权重指标性质
A医共体建设成效就医格局A1县域内住院人次占比（%）0.015正向
A2县域就诊率（%）0.006正向
A3县域内基层医疗卫生机构门急诊占比（%）0.025正向
A4县域内基层医疗卫生机构中医药门急诊占比（%）0.056正向
A5牵头医院下转患者数量占比（%）0.127正向
A6慢病患者基层医疗卫生机构管理率（%）0.021正向
A7基层医疗卫生机构人均收入与牵头医院人均收入的比值0.027正向
服务能力A8牵头医院是否达到县级综合医院或中医医院综合能力推荐标准占比（%）0.160正向
A9牵头医院出院患者三四级手术比例（%）0.010正向
A10区域内万人口全科医生数（1/万）0.101正向
A11牵头医院帮助基层开展新技术、新项目的数量（个）0.108正向
A12“优质服务基层行”活动达到基本标准和推荐标准的机构数量（个）0.052正向
A13国家基本公共卫生服务项目实施情况（百分制）0.008正向
资源利用A14牵头医院医疗服务收入占医疗收入的比例（%）0.031正向
A15基层医疗卫生机构医疗服务收入占医疗收入的比例（%）0.018正向
A16基层医疗卫生机构医师日均担负诊疗人次0.030正向
A17基层医疗卫生机构床位使用率（%）0.022正向
A18牵头医院人员经费占业务支出比例（%）0.010正向
A19基层医疗卫生机构财政补助收入占总收入的比例（%）0.034正向
医保效能A20医保基金县域内支出率（不含药店）（%）0.018正向
A21县域内基层医疗卫生机构医保基金占比（%）0.043正向
A22医保考核结果（百分制）0.011正向
A23县域门诊次均费用（元）0.012负向
A24参保人员住院次均费用（元）0.020负向
A25住院费用实际报销比（%）0.016正向
A26参保人员年住院率（%）0.020负向
B经济发展水平经济总量B1地区生产总值（亿元）0.115正向
B2社会消费品零售总额（亿元）0.104正向
B3一般公共预算收入(亿元)0.181正向
经济结构B4第二产业增加值（亿元）0.190正向
B5第三产业增加值（亿元）0.099正向
经济效益B6人均地区生产总值（元）0.246正向
B7人均可支配收入（元）0.064正向
), ArticleFig(id=1241821868596986719, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=EN, label=Table 4, caption=

Comprehensive evaluation index and coupled coordination values for each pilot county

, figureFileSmall=null, figureFileBig=null, tableContent=
试点县S1S2S1-S2CTD
A10.2900.0740.2160.8060.1820.383
A20.4340.1420.2920.8620.2880.498
A30.2950.302-0.0081.0000.2980.546
A40.4010.1980.2030.9410.2990.531
A50.2100.301-0.0910.9840.2560.502
A60.1810.0730.1080.9040.1270.338
A70.3090.0610.2480.7420.1850.371
A80.5690.0720.4970.6310.3210.450
A90.2630.267-0.0051.0000.2650.515
A100.2830.298-0.0151.0000.2900.539
A110.2030.0890.1150.9200.1460.366
A120.2980.391-0.0930.9910.3440.584
A130.2630.598-0.3350.9210.4310.630
A140.4210.2760.1460.9780.3490.584
A150.2010.696-0.4950.8340.4490.612
A160.4390.3260.1130.9890.3820.615
A170.3920.2640.1280.9810.3280.567
A180.3060.2530.0540.9950.2800.528
A190.4990.2220.2770.9230.3610.577
A200.5000.2920.2080.9650.3960.618
A210.4290.4220.0071.0000.4260.653
A220.2430.409-0.1660.9670.3260.562
A230.4160.1640.2520.9010.2900.511
A240.4670.1500.3170.8580.3080.514
A250.3410.3210.0201.0000.3310.575
A260.1750.0270.1490.6790.1010.262
A270.2640.0130.2520.4170.1380.240
A280.3870.0580.3280.6750.2230.388
A290.3740.0210.3530.4510.1980.298
A300.2230.0970.1260.9200.1600.384
A310.2770.1330.1440.9360.2050.438
A320.2940.1440.1490.9400.2190.454
A330.1940.0820.1120.9140.1380.355
A340.3330.0460.2870.6520.1900.352
A350.3780.1400.2380.8880.2590.480
A360.3240.1050.2190.8600.2150.430
A370.3040.0540.2500.7180.1790.359
A380.2810.0730.2080.8090.1770.379
A390.3210.1040.2170.8600.2130.428
均值0.3280.1990.1290.8670.2630.472
), ArticleFig(id=1241821868739593065, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=CN, label=表4, caption=

各试点县综合评价指数和耦合协调值

, figureFileSmall=null, figureFileBig=null, tableContent=
试点县S1S2S1-S2CTD
A10.2900.0740.2160.8060.1820.383
A20.4340.1420.2920.8620.2880.498
A30.2950.302-0.0081.0000.2980.546
A40.4010.1980.2030.9410.2990.531
A50.2100.301-0.0910.9840.2560.502
A60.1810.0730.1080.9040.1270.338
A70.3090.0610.2480.7420.1850.371
A80.5690.0720.4970.6310.3210.450
A90.2630.267-0.0051.0000.2650.515
A100.2830.298-0.0151.0000.2900.539
A110.2030.0890.1150.9200.1460.366
A120.2980.391-0.0930.9910.3440.584
A130.2630.598-0.3350.9210.4310.630
A140.4210.2760.1460.9780.3490.584
A150.2010.696-0.4950.8340.4490.612
A160.4390.3260.1130.9890.3820.615
A170.3920.2640.1280.9810.3280.567
A180.3060.2530.0540.9950.2800.528
A190.4990.2220.2770.9230.3610.577
A200.5000.2920.2080.9650.3960.618
A210.4290.4220.0071.0000.4260.653
A220.2430.409-0.1660.9670.3260.562
A230.4160.1640.2520.9010.2900.511
A240.4670.1500.3170.8580.3080.514
A250.3410.3210.0201.0000.3310.575
A260.1750.0270.1490.6790.1010.262
A270.2640.0130.2520.4170.1380.240
A280.3870.0580.3280.6750.2230.388
A290.3740.0210.3530.4510.1980.298
A300.2230.0970.1260.9200.1600.384
A310.2770.1330.1440.9360.2050.438
A320.2940.1440.1490.9400.2190.454
A330.1940.0820.1120.9140.1380.355
A340.3330.0460.2870.6520.1900.352
A350.3780.1400.2380.8880.2590.480
A360.3240.1050.2190.8600.2150.430
A370.3040.0540.2500.7180.1790.359
A380.2810.0730.2080.8090.1770.379
A390.3210.1040.2170.8600.2130.428
均值0.3280.1990.1290.8670.2630.472
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Coupling type of each pilot county

, figureFileSmall=null, figureFileBig=null, tableContent=
耦合阶段试点县数量（个）
无关状态无0
低水平耦合无0
颉颃A27、A252
磨合A7、A8、A26、A28、A34、A376
高水平耦合A1、A2、A4、A5、A6、A11、A12、A13、A14、A15、A16、A17、A18、A19、A20、A22、A23、A24、A30、A31、A32、A33、A35、A36、A38、A3926
良性共振耦合A3、A9、A10、A21、A255
), ArticleFig(id=1241821870434091897, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=CN, label=表5, caption=

各试点县耦合度类型

, figureFileSmall=null, figureFileBig=null, tableContent=
耦合阶段试点县数量（个）
无关状态无0
低水平耦合无0
颉颃A27、A252
磨合A7、A8、A26、A28、A34、A376
高水平耦合A1、A2、A4、A5、A6、A11、A12、A13、A14、A15、A16、A17、A18、A19、A20、A22、A23、A24、A30、A31、A32、A33、A35、A36、A38、A3926
良性共振耦合A3、A9、A10、A21、A255
), ArticleFig(id=1241821870593475454, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=EN, label=Table 6, caption=

Coupling and coordination types of pilot counties

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耦合协调类型试点县数量（个）
良好协调无0
中度协调A13、A15、A16、A20、A215
勉强协调A2、A3、A4、A5、A8、A9、A10、A12、A14、A17、A18、A19、A22、A23、A24、A25、A31、A32、A35、A36、A3921
中度失调A1、A6、A7、A11、A26、A27、A28、A29、A30、A33、A34、A37、A3813
严重失调无0
), ArticleFig(id=1241821870748664709, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=CN, label=表6, caption=

各试点县耦合协调类型

, figureFileSmall=null, figureFileBig=null, tableContent=
耦合协调类型试点县数量（个）
良好协调无0
中度协调A13、A15、A16、A20、A215
勉强协调A2、A3、A4、A5、A8、A9、A10、A12、A14、A17、A18、A19、A22、A23、A24、A25、A31、A32、A35、A36、A3921
中度失调A1、A6、A7、A11、A26、A27、A28、A29、A30、A33、A34、A37、A3813
严重失调无0
), ArticleFig(id=1241821870874493840, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=EN, label=Table 7, caption=

Global spatial autocorrelation analysis results of coupling coordination degree between two systems in pilot counties

, figureFileSmall=null, figureFileBig=null, tableContent=
Moran IZ值P值
0.5423.1260.001
), ArticleFig(id=1241821871017100185, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=CN, label=表7, caption=

试点县两系统耦合协调度全局空间自相关分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
Moran IZ值P值
0.5423.1260.001
), ArticleFig(id=1241821871159706527, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=EN, label=Table 8, caption=

Local spatial autocorrelation analysis results of coupling coordination degree between two systems in pilot counties

, figureFileSmall=null, figureFileBig=null, tableContent=
聚集类型数量（个）试点县
高-高聚集2A19、A22
低-低聚集1A28
高-低聚集2A24、A25
低-高聚集0无
不显著34非以上地区
), ArticleFig(id=1241821871319090089, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676527608328663, language=CN, label=表8, caption=

试点县两系统耦合协调度局部空间自相关分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
聚集类型数量（个）试点县
高-高聚集2A19、A22
低-低聚集1A28
高-低聚集2A24、A25
低-高聚集0无
不显著34非以上地区
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广西紧密型县域医共体试点地区建设成效与经济发展水平的耦合协调及空间特征分析
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张兴隆 1, 2 , 黄凌波 1, 2 , 覃娴静 1, 2 , 陈丽丽 1, 2 , 冯俊 1
现代预防医学 | 卫生政策与管理 2024,51(21): 3936-3940
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现代预防医学 | 卫生政策与管理 2024, 51(21): 3936-3940
广西紧密型县域医共体试点地区建设成效与经济发展水平的耦合协调及空间特征分析
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张兴隆1, 2, 黄凌波1, 2, 覃娴静1, 2, 陈丽丽1, 2, 冯俊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

    • 张兴隆（1997—），男，硕士在读，研究方向：卫生事业管理

通讯作者:

冯俊，E-mail:
Analysis of the coupling coordination and spatial characteristics between the construction achievements of the tight-knit county medical community pilot areas and economic development levels in Guangxi
Xing-long ZHANG1, 2, Ling-bo HUANG1, 2, Xian-jing QIN1, 2, Li-li CHEN1, 2, Jun FENG1
Affiliations
  • Research Center for Health and Health Policy, Guangxi Medical University (A Unit for the Cultivation of High-end Think Tanks), Nanning, Guangxi 530021, China
出版时间: 2024-11-10 doi: 10.20043/j.cnki.MPM.202405022
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摘要
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目的

分析2022年广西39个紧密型县域医共体试点县建设成效和区域经济发展水平两系统的耦合协调关系。

方法

运用耦合协调度模型分析两系统的耦合协调度；利用Moran I指数对耦合协调度进行空间相关性分析。

结果

紧密型县域医共体建设成效与区域经济发展水平耦合协调类型为中度协调的试点县有5个，占12.82%；勉强协调的有21个，占53.85%；中度失调有13个，占33.33%；全局Moran I指数为0.542。

结论

两系统耦合协调度有待提高；医共体建设成效整体超前于区域经济发展水平；耦合协调度存在地区差异，各试点县在推进医共体建设方面相互合作性不强。建议要加强合作交流，推进区域经济高质量发展，促进优质医疗卫生资源合理配置。

县域医共体  /  成效  /  经济水平  /  耦合协调  /  空间自相关
Objective

To analyze the coupling coordination relationship between the construction achievements of the 39 tight-knit county medical community pilot counties in Guangxi and the regional economic development levels in 2022.

Methods

The coupling coordination degree model was used to analyze the coupling coordination degree of the two systems. Moran I index was employed to conduct spatial correlation analysis of the coupling coordination degree.

Results

Among the pilot counties, five counties (12.82%) exhibited a moderate coordination type between the construction achievements and regional economic development levels; 21 counties (53.85%) were in a barely coordinated state; and 13 counties (33.33%) showed moderate disorder.The global Moran I index was 0.542.

Conclusion

The coupling coordination degree of the two systems needs improvement; the achievements of the medical community construction are generally ahead of the regional economic development levels; there are regional disparities in coupling coordination degree, and mutual cooperation among the pilot counties in advancing the medical community construction is weak. It is recommended to strengthen cooperation and communication, promote high-quality regional economic development, and facilitate the rational allocation of quality medical and health resources.

County medical community  /  Achievements  /  Economic level  /  Coupling coordination  /  Spatial autocorrelation
张兴隆, 黄凌波, 覃娴静, 陈丽丽, 冯俊. 广西紧密型县域医共体试点地区建设成效与经济发展水平的耦合协调及空间特征分析. 现代预防医学, 2024 , 51 (21) : 3936 -3940 . DOI: 10.20043/j.cnki.MPM.202405022
Xing-long ZHANG, Ling-bo HUANG, Xian-jing QIN, Li-li CHEN, Jun FENG. Analysis of the coupling coordination and spatial characteristics between the construction achievements of the tight-knit county medical community pilot areas and economic development levels in Guangxi[J]. Modern Preventive Medicine, 2024 , 51 (21) : 3936 -3940 . DOI: 10.20043/j.cnki.MPM.202405022
正文
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县域医共体建设是优化医疗资源配置的一项重要举措，加快县域医共体的建设有助于更好满足人民群众的健康需求，同时健康的人口能够促进经济发展，而经济发展又是推动县域医共体建设的前提和保障，两者相互作用。目前，关于医共体的研究多以基层卫生机构和牵头医院为研究对象，应用DEA等方法对其运行效率进行评价[1-2]，或从医共体整体角度出发，从分级诊疗[3]、医防融合[4]、医保支付方式改革等方面进行探讨[5-6]，或是运用描述性分析等方法对试点地区的实践效果进行评价[7-8]，但针对医共体试点地区建设成效与经济发展水平二者协调发展的研究并不多。因此，本研究选择广西39个紧密型县域医共体试点县为研究对象，运用熵值法，分别测算2022年医共体的建设成效和区域经济发展水平，并利用耦合协调度模型分析两者的耦合协调关系，为促进两者的协同发展提供依据。
1　资料与方法
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1.1　资料来源
本研究以广西39个紧密型县域医共体试点县为研究对象。医共体建设成效评价指标数据来自“国家紧密型县域医共体建设试点监测平台”。区域经济发展水平评价指标数据来自“广西统计年鉴”。
1.2　熵权法
熵权法是一种确定客观权重的方法，其原理是根据评价指标所带给决策者信息量的多少来确定各评价指标的权重[9-10]。基于熵权法计算得出的指标权重和标准化处理结果，计算综合评价得分。以S1和S2依次表示建设成效与区域经济发展水平的综合评价得分。S1>S2表示经济发展水平滞后，S1=S2表示两者同步发展，S1<S2表示医共体建设滞后。
1.3　耦合协调度模型
耦合度是指两个及以上系统之间的相互作用程度，协调度可以反映系统协调程度[11]。本文参考相关文献[12-13]，将耦合度大小划分为6个阶段，见表1，将耦合协调类型划分为5类，见表2。其中，C为耦合度，T为协调度，D为耦合协调度。
1.4　空间相关分析
使用GeoDa软件对各试点县的耦合协调度进行空间自相关分析。全局Moran I指数，取值范围介于[-1,1]之间。I<0，表明空间上呈现负相关性；I>0，为正相关；I=0表示在空间上呈随机分布[13]。
1.5　指标选取
本文基于《关于印发紧密型县域医疗卫生共同体建设评判标准和监测指标体系（试行）的通知》中的26个监测指标，构建医共体建设成效指标体系。同时结合相关文献分析[14-16]，构建区域经济发展水平评价指标体系，见表3。
2　结果
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2.1　各试点县建设成效与经济发展水平的综合评价
39个试点县中有8个试点县的建设成效综合评价指数小于经济发展水平综合评价指数，占20.5%；31个试点县的建设成效综合评价指数大于经济发展水平综合评价指数，占79.5%。见表4。
2.2　各试点县建设成效与经济发展水平的耦合度
整体来看，各试点县的耦合度均值为0.867，两系统处于高水平耦合阶段。从39个试点县来看，处于颉颃状态的试点县有2个，占5.12%；处于磨合状态的试点县有6个，占15.38%；处于高水平耦合的试点县有26个，占66.67%；处于良性共振耦合的试点县有5个，占12.82%。见表5。
2.3　各试点县建设成效与经济发展水平的耦合协调类型
从各试点县来看，紧密型县域医共体建设成效与区域经济发展水平耦合协调类型为中度协调的试点县有5个，占12.82%；勉强协调的有21个，占53.85%；中度失调有13个，占33.33%；没有良好协调和严重失调的试点县。见表6。
2.4　各试点县建设成效与经济发展水平的耦合协调度空间相关性分析
全局Moran I指数为0.542（P<0.05），见表7。局部Moran I指数分析结果显示，呈现高—高聚集的试点县为A19、A22；呈现低—低聚集的试点县为A28；呈现高—低聚集的试点县为A24、A25，见表8。
3　讨论
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3.1　医共体建设成效与经济发展水平耦合协调度有待提高
研究结果显示各试点县耦合协调度仍有较大的进步空间。究其原因，可能是医共体建设成效与经济发展水平两者的发展速度不一致等因素有关。一方面，广西属于少数民族边境地区，各试点县经济发展相对落后，在目前大力推进医共体的形势下，医共体建设成效与区域经济发展水平可能存在一定程度不适配的问题。另一方面，卫生资源配置仍存在的不平衡不充分现象，导致部分地区人、财、物等医疗资源相对匮乏，难以有效提高医共体的建设成效，致使耦合协调度较低。从对各试点县基层医疗卫生机构实地调研情况来看，不同地区的基层医疗卫生机构从规模、设备、设施等方面上都表现出显著的差异。仍有许多基层医疗卫生机构面临缺人、缺设备的困境。建议各试点县要发挥比较优势，制定差异化经济发展战略，同时不断促进优质医疗卫生资源下沉和区域均衡布局，持续助力紧密型县域医共体建设[11]。
3.2　医共体建设成效整体超前于区域经济发展水平
研究结果显示医共体建设成效整体超前于区域经济发展水平。究其原因，一方面广西属于西部欠发达地区，各试点县的经济发展相对落后。另一方面，“十三五”以来广西政府重点加强基层医疗卫生机构服务能力建设，实施多项乡镇卫生院新建基建项目和设备购置项目，着力改善了县、乡两级医疗卫生机构办医条件。同时，广西通过加强人才培养，强化人员培训，落实待遇保障等举措，不断壮大基层卫生人才队伍。基层医疗卫生人员由2012年的12.52万人上升到17.40万人，增长38.95%。各项举措极大促进了医共体的建设。因此导致了医共体建设成效整体超前于区域经济发展水平。建议县域医共体医疗资源配置供给应以当前区域经济发展水平为基准，避免与经济发展不相适应的医疗资源超前配置或滞后供给，从而达到协调发展的目的[17]。
3.3　耦合协调度存在地区差异，且各试点县在推进医共体建设方面相互合作性不强
研究结果显示各试点县耦合协调度在空间布局上表现为整体较为分散、局部小范围聚集的特点，各试点县间带动效应整体发挥不足，例如南宁、柳州等耦合协调度较高、医共体建设成效较好的地区并没有与百色、河池等邻近接壤的试点县形成高-高聚集的特征，表明各试点县在推进医共体建设方面没有发挥辐射带动作用。究其原因，一方面可能是各试点县仍处于不断探索阶段，还无法对邻近试点县起到带动作用；另一方面可能是因为医共体的建设基于一定的经济基础，经济发展水平高的地区在推行医共体上更具优势，而经济发展水平较差的试点县无法借鉴这种优势。因此，各试点县需加强合作交流，形成“以强带弱”或“强强联合”的局面。同时鼓励引导社会力量办医疗机构加入县域医共体，形成多元办医格局，将基层医疗资源配置的“短板”转化为经济新增长点[17]。
基金
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  • 2023年度广西特色新型智库联盟重大专题研究项目(GXZC2023-C3-001424-GTZX)
文献
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2024年第51卷第21期
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doi: 10.20043/j.cnki.MPM.202405022
  • 接收时间：2024-05-02
  • 首发时间：2026-03-20
  • 出版时间：2024-11-10
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  • 收稿日期：2024-05-02
基金
2023年度广西特色新型智库联盟重大专题研究项目(GXZC2023-C3-001424-GTZX)
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
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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
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