新医改背景下成都市医疗资源空间优化配置研究

In order to meet the increasing healthy and medical demand of the public，more stress should be placed on the functional hierarchy of healthcare system, the accessibility of healthcare services and the efficiency of healthcare resources. However, the functional hierarchy position and the spatial allocation of medical resources are neither clear nor rational currently. Hierarchical Medical System is a major initiative to solve the problem of medical resources spatial mismatch and to form a new pattern of scientific and reasonable medical treatment. This project sets out from the research perspective of integration and function reconfiguration of medical resources, will apply multidisciplinary approaches of human geography, public management and health economics to analyze spatial allocation efficiency of medical resources and spatial accessibility of healthcare services, taking Chengdu city as an example. Research methods, such as social and spatial empirical investigation, the Stakeholder Analysis, the improved Two-step Floating Catchment Area Method, spatial econometrics and the Particle Swarm Optimization method, will be use to do this research. This project will analyze the corresponding mechanism between the spatial structure of medical resources and spatial behavior of the public medical treatment, illustrate the spatial allocation pattern, function and efficiency of medical resources, and then, quantitatively evaluate the accessibility of healthcare services as well as its spatial distribution and influencing factors on the situation of building Hierarchical Medical System. Finally, this project will propose recommendations for optimizing spatial allocation of medical resources and improving efficiency of healthcare services under the background of the New Healthcare Reform.

公众医疗和健康需求日益增长和多元化，更加强调医疗体系功能的层级性、医疗服务的空间可达性和医疗资源配置的效率性，而目前医疗资源功能层级定位不明确、空间配置不合理，导致供需矛盾突出。分级诊疗是解决医疗资源空间错配、形成科学合理的就医新格局的重要举措。本项目基于分级诊疗改革背景下医疗资源整合、功能重构的研究视角，针对医疗资源空间配置及其效率、医疗服务空间可达性等热点问题，运用人文地理学、公共管理学和卫生经济学等多学科方法，以成都市分级诊疗医疗联合体为例，集成应用人文与空间混合实证调查法、利益相关者分析法、改进的两步移动搜索法、空间计量经济学模型和粒子群算法，解析医疗资源空间结构与公众就医空间行为互馈机制，阐明医疗资源空间配置格局、功能与效率，定量测度分级分类就诊情景下的医疗服务空间可达性及其空间格局和驱动因素，最终提出新医改背景下医疗资源空间优化配置和效率增进策略。

项目以分级诊疗背景下医疗资源供需均衡为视角，对多层级医疗资源体系的空间结构、服务功能与多元化公众就医行为的空间关联机制进行了研究。运用探索性空间分析法、地理探测器和动态空间面板回归模型分析了全国两层级医疗资源的空间配置特征与影响机制；提出了全新的“2R-GTL”空间可达性评估方法，揭示了大城市多层级医疗资源的空间均衡性特征并识别了缺医区。构建了包括医疗资源、人口、自然、经济和社会属性的空间数据库，获得医护人员问卷和公众就医空间行为偏好问卷共1782份。项目研究结果表明：我国两层级医疗资源呈显著空间聚集特征，层级间空间配置格局具有差异性，不同尺度和区域两层级医疗资源配置的决定力及其影响强度不同，上层医疗资源对外部影响因素响应强度大于基层。因不同层级医疗资源功能的差异性和居民就医空间行为偏好的多元性，成都市不同层级医疗机构的空间可达性具有显著差异性，大型综合医院具有最高可达性而社区医疗卫生机构具有最低可达性，缺少基层医疗机构是缺医区中突出的问题，多层级缺医区主要聚集于人口稀少的山区，以及部分郊区和行政交界地带的人口密集区。项目基于研究结果，提出在公平性与效率性的双重要求下，对不同类型区域和不同功能层级医疗机构实施差异化空间优化配置的策略建议。项目开展过程中共发表学术论文11篇，包括5篇SCIE/SSCI期刊论文（2篇1区），出版学术专著1部，培养了4名硕士研究生。依托该项目成果，项目负责人晋升为教授，2名项目成员申请到国家留学基金项目。