关键词: 失配度, 基层医疗资源配置, 双层规划模型, 时空格局

Abstract: Background　With the aging of the population and the increase of the proportion of patients with chronic diseases, the people 's demand for primary medical resources is diversified and complicated. There are differences in the demand for primary medical resources among different regions and different groups of people. Some areas are facing the problem of lack of primary medical resources, which seriously restricts the coverage and quality of primary medical and health services, and greatly affects the medical experience and health status of residents. Objective　In order to promote the high-quality development of the primary medical and health service system, the health distance model is introduced to analyze the spatial and temporal evolution process of the allocation mismatch of primary medical resources in China from 2011 to 2021, so as to provide reference for rationally formulating regional health plans, optimizing the allocation of medical resources, improving the capacity of primary medical and health services, and promoting the high-quality development of medical and health services. Methods　The evaluation index system of the mismatch degree of primary medical resources was established from the three levels of health human resources, financial resources and material resources. The data were obtained from the China Health and Family Planning Statistical Yearbook and the China Statistical Yearbook. The bi-level programming model and the health distance model were used to measure the mismatch degree of primary medical resources allocation from 2011 to 2021. Results　From 2011 to 2021, the overall mismatch of primary medical resources allocation in China has a significant downward trend, but the internal differences of inter-regional and inter-provincial mismatches continue to expand. The average values of mismatch in the eastern, central and western regions in 2011 were 0.764,0.760 and 0.847, respectively, which were moderate mismatch, good mismatch and severe mismatch. In 2021, the average values of mismatch in the eastern, central and western regions are 0.595, 0.624 and 0.747, respectively, and the three regions are all mildly mismatched. Conclusion　Promoting the expansion of high-quality medical resources and promoting the balanced layout of regional medical resources are the premise of building a high-quality and efficient medical and health service system. In order to further optimize the allocation of primary medical resources and improve China 's medical and health service system, we should formulate reasonable macro policies in combination with the characteristics of each region, improve the level of economic development, optimize the structure of fiscal expenditure, improve the administrative capacity of local governments, reduce the mismatch of primary medical resources allocation, and realize the high-quality development of primary medical and health service system.

Key words: Mismatch, Allocation of primary medical resources, Bi-level programming model, Space-time pattern