Khan M M, Ali D, Ferdousy Z, Al-Mamun A
Department of Health Systems Management, Tulane University School of Public Health, New Orleans, Louisiana 70112, USA.
Health Policy Plan. 2001 Sep;16(3):264-72. doi: 10.1093/heapol/16.3.264.
This paper illustrates a method of planning the geographic distribution of health facilities in order to maximize the social benefits achievable from the investment. Data from Bangladesh have been used to determine the optimal distribution of emergency obstetric care (EOC) facilities in the country using the estimates of average social cost per woman. Costs incurred by households, including the costs associated with maternal mortality, tend to increase with increasing radius of a facility's catchment area. The average facility-based costs tend to decline with increasing radius due to lower per capita capital expenditures. The summation of these two average cost functions generates a U-shaped curve. In this research, the minimum point of the aggregated average cost curve defines the 'optimal' radius of a health facility. The catchment area defined by the optimal radius minimizes the average social cost of providing EOC services in a region. The empirical analysis suggests that the optimal radius for the 20 regions of Bangladesh varies from about 6 to 12 km. If the optimal radius of the catchment area is used in planning health centre locations, Bangladesh will need to set up 450 EOC facilities; currently there are only 90 such facilities.
本文阐述了一种规划卫生设施地理分布的方法，以便使投资所能实现的社会效益最大化。利用孟加拉国的数据，通过估计每位妇女的平均社会成本，来确定该国紧急产科护理（EOC）设施的最优分布。家庭所承担的成本，包括与孕产妇死亡相关的成本，往往会随着设施服务半径的增加而上升。由于人均资本支出降低，基于设施的平均成本往往会随着半径的增加而下降。这两个平均成本函数的总和会产生一条U形曲线。在本研究中，总平均成本曲线的最低点定义了卫生设施的“最优”半径。由最优半径定义的服务区域可使在一个地区提供EOC服务的平均社会成本最小化。实证分析表明，孟加拉国20个地区的最优半径在约6至12公里之间变化。如果在规划卫生中心位置时使用服务区域的最优半径，孟加拉国将需要设立450个EOC设施；目前该国仅有90个此类设施。
