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

摘要： 背景　随着人口老龄化和慢性病患者比例的增加，人民群众对基层医疗资源的需求呈多样化、复杂化的态势。不同地区、不同人群对基层医疗资源的需求存在差异，部分地区面临基层医疗资源匮乏的问题，严重制约基层医疗卫生服务的覆盖率和质量，极大影响居民的就医体验和健康状况。目的　为推动基层医疗卫生服务体系高质量发展，引入健康距离模型，分析2011-2021年我国基层医疗资源配置失配度的时空演变过程，为合理制订区域卫生规划，优化医疗资源配置方案、提高基层医疗卫生服务能力、推动医疗卫生服务高质量发展提供参考。资料与方法　从卫生人力、财力、物力资源三个层面建立基层医疗资源失配度评价指标体系，从《中国卫生和计划生育统计年鉴》《中国卫生健康统计年鉴》《中国统计年鉴》获取数据，采用双层规划模型和健康距离模型测算2011-2021年基层医疗资源配置失配度。结果　2011—2021年我国基层医疗资源配置整体失配度有明显的下降趋势，但是区际、省际间失配度的内部差异不断扩大。2011年东、中、西部地区失配度平均值分别为0.764、0.760、0.847，分别为中度度失配、良好和重度度失配。2021年东、中、西部地区失配度平均值分别为0.595、0.624、0.747，三大区域均属于轻度失配。结论　促进优质医疗资源扩容、推动区域医疗资源均衡布局是建设优质高效的医疗卫生服务体系的前提。为进一步优化基层医疗资源配置，完善我国医疗卫生服务体系，应结合各区域特点，制定合理的宏观政策，提高经济发展水平，优化财政支出结构，提高地方政府行政能力，降低基层医疗资源配置失配度，实现基层医疗卫生服务体系高质量发展。

关键词: 失配度, 基层医疗资源配置, 双层规划模型, 时空格局