Page 113 - 中国全科医学2022-10

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【Abstract】 Background The allocation of medical resources in China has been in an "inverted triangle" state
for a long time. The unreasonable allocation of grass-roots medical resources is difficult to meet the increasingly diversified
needs of medical services. The coupling and coordination between the allocation of grass-roots medical resources and economic
development will affect the level of regional economic development and the service capacity of grass-roots medical institutions. At
present，there is a lack of research on the current situation of their coordinated development and how their influencing factors work
through combination. Objective To assess the level of coordinated development of primary care resource allocation and economy
in China，and to determine the associated factors，providing a decision-making basis for further improving medical resource
allocation and planning. Methods The research was carried out from November 2020 to April 2021. Data were collected from
China Health Statistics Yearbook 2019 and China Statistical Yearbook 2019. fsQCA was implemented to assess the influence of
the number of licensed（assistant） doctors，number of registered nurses, financial subsidy for part of salary，number of beds，
number of primary care institutions，regional gross domestic product（GDP），regional fiscal revenue，per capita disposable
income，and per capita GDP（used as conditional variables） on the level of interconnected，coordinated development level
of primary care resource allocation and economic level（the outcome variable） in 31 regions of China. Results In 2018，
only the mean level of interconnected，and coordinated development of primary care resource allocation and economy in eastern
China（0.61） was within the range（0.6，1.0] of coordinated development, and that in central China（0.50） was within the
transitional harmony range（0.4，0.6]，while that in western China（0.38） was within the range of imbalanced and recessional
development[0，0.4]. The coordinated development of primary care resource allocation and economic level were found to be
affected by many factors，and it may be facilitated by four configurations of its associated factors revealed by the configuration
analysis：（1）number of beds * number of licensed（assistant） doctors * number of registered nurses * number of primary
care institutions * financial subsidy for part of salary* ~ per capita disposable income * ~ per capita GDP；（2）~ number of
beds * ~ number of licensed（assistant） doctors * number of registered nurses * number of primary care institutions * ~ financial
subsidy for part of salary* regional GDP * ~ per capita disposable income * per capita GDP；（3）number of licensed（assistant）
doctors * number of registered nurses * number of primary care institutions * financial subsidy for part of salary * regional GDP
* regional fiscal revenue * per capita disposable income * per capita GDP；（4）~ number of beds * ~ number of licensed
（assistant） doctors * ~ number of registered nurses * ~ number of primary care institutions * financial subsidy for part of salary
* regional GDP * regional financial income * per capita disposable income * per capita GDP（* for "and"，~ for "not"）. And
these four configurations could be classified into three types of paths：primary care resource allocation-driven type，primary
care resource allocation and economic balance type，and economic development-driven type. Conclusion The overall level
of coordinated development of primary care resource allocation and economy in China was unsatisfactory，with obvious regional
differences，which was mainly affected by the number of registered nurses，regional GDP，and regional fiscal revenue，but may
be facilitated greatly by the above-mentioned four configurations of associated factors. Therefore，it is suggested that each region
chooses one path to achieve high level of interconnected，and coordinated development of primary care resource allocation and
economy according to their own resources and conditions，so as to promote the rational primary care resource allocation，and the
coordinated development of medical resources and economic level，thereby improving the level of primary care services in China.
【Key words】 Health resources；Resource allocation；Primary health care institutions；Economic development；
Coupling coordinated development；Qualitative comparative analysis

基层医疗卫生机构是提供基本医疗和基本公共卫生 级诊疗制度、积极推进医联体和医共体建设等具体举措
服务的重要载体，是国家医疗卫生服务体系的基石，也 来促进医疗资源下沉，进而提升基层医疗卫生机构的服
是保障居民健康需求的首要环节 ［1］ 。2016 年 10 月中 务能力 ［4-5］ 。我国目前正处于经济高速增长向高质量
共中央 国务院印发《“健康中国 2030”规划纲要》， 发展的过渡阶段，经济发展是促进卫生事业发展与实
在战略主题及目标中提出要“坚持以基层为重点”“建 现国民健康目标的前提和保证，而卫生支出的增长也会
立覆盖城乡居民的中国特色基本医疗卫生制度” ［2］ 。 相对应地刺激经济增长 ［6］ ，基层医疗卫生机构作为我
我国卫生资源配置呈“倒三角”状态 ［3］ ，针对基层医 国医疗卫生服务体系的重要组成部分，其资源配置的公
疗卫生机构医疗资源匮乏、服务能力不足等问题，我国 平、合理及与经济发展的适应情况也会影响区域经济发
政府提出了以“保基本、强基层、建机制”为基调的新 展水平的提升 ［7］ 。目前，学者们主要通过泰尔指数、
一轮医疗卫生体制改革，明确了统筹安排、突出重点的 基尼系数方法从基层医疗资源配置与经济发展的内在联
改革策略，出台了一系列重大改革措施，并通过实施分 系 ［8］ 、基本医疗服务均等化与经济增长的相互促进关