摘要
三级甲等医院是中国最优质的医疗资源,但其空间分布很不均衡,在地理可及性方面导致“看病难”。本文首先建构了一个初步的医院嵌入分层理论,阐述了公立医院所嵌入的“条”“块”结构,以及评定医院服务质量和技术水平的“等”“级”制度。接下来运用空间分析方法刻画三甲医院的空间分布特征和空间依赖特征,并使用传统的最小二乘法(OLS)、空间滞后模型(SLM)和空间误差模型(SEM)分析其影响因素。研究结果表明:(1)三甲医院不仅在地级市层面有所集聚,在区域甚至全国层面也有着显著的空间分异;(2)三甲医院数量分布与地区经济体量和城镇化发展水平显著相关;(3)城市的行政级别以及是否有医学院也对三甲医院分布产生重要影响,这表明实证分析支持嵌入分层理论的推断。最后,本文建议通过建设欠发达地区的三甲医院和发展“互联网+医疗”来改善优质医疗资源的空间可及性。
The top tertiary hospitals are the best medical resources in China,but their spatial distribution is very uneven,which leads to access to care problem in terms of geographical accessibility.This paper firstly developed a preliminary theory of embedded stratification on public hospitals,which expounded the Tiao and Kuai structure that public hospitals were embedded,as well as the Class and Level system for evaluating the service quality and technical level of hospitals.Secondly the spatial analysis method was used to describe the spatial distribution characteristics and spatial dependence characteristics of the top tertiary hospitals,and the influence factors were analyzed by the traditional ordinary least square method(OLS),spatial lag model(SLM)and spatial error model(SEM).The results show that:(1)The top tertiary hospitals are not only clustered at the prefecture-level city level,but also have significant spatial differentiation at the regional and even national level.(2)The distribution of the number of top tertiary hospitals is significantly associated with the regional economic volume and urbanization level;(3)The administrative level of a city and the availability of medical college also have an important impact on the distribution of top tertiary hospitals,which indicates that empirical analysis supports the inference of embedded stratification theory.Finally,this paper proposes to improve the spatial accessibility of high-quality medical resources by building top tertiary hospitals in underdeveloped areas and developing Internet+Medicine.
作者
时保国
吴少龙
Shi Baoguo;Wu Shaolong(School of Economics,Minzu University of China,Beijing 100081;School of Public Health,Sun Yat-Sen University,Guangzhou 510080)
出处
《甘肃行政学院学报》
CSSCI
北大核心
2019年第5期94-103,128,共11页
Journal of Gansu Administration Institute
基金
教育部人文社科青年基金项目“基于产业链分工和产业融合测度分析的两岸产业合作研究”(19YJCGAT004)
中山大学国家治理研究院“中国医疗卫生机构大数据采集、结构化与挖掘”(99123-52143210)
关键词
看病难
三甲医院
嵌入分层
空间分析
Access to care
Top tertial hospital
Embedded stratification
Spatial analysis
