Zwarenstein M F, Price M R
Centre for Epidemiological Research, South African Medical Research Council, Parowvallei, CP.
S Afr Med J. 1990 May 5;77(9):448-52.
This study used published data to analyse the 1983 distribution of hospitals and hospital beds in South Africa by 'race', geographical area, type of hospital (academic, specialist, general or other) and the nature of ownership (e.g. state, for-profit). Hospitals and hospital beds were found to be inequitably distributed. Overall bed ratios were 150 whites per bed compared with 260 blacks/Asians/coloureds per bed. The distribution of beds by geographical area was 130 people per bed for urban whites, 260 for rural whites and 150, 460 and 300 for urban, rural non-'homeland', and 'homeland' blacks/Asians/coloureds respectively. These differentials are inefficient and unjust, and should be regularly documented to spur their decline. The continued collection of population group information from health service users is required to monitor changes in 'race' disparities. The analysis of distribution by ownership and type suggested that only the public sector is able to provide a hospital service with the appropriate balance of all levels of care for the entire population; but within this sector the dominant position of tertiary care needs to be re-examined. The study highlighted the absence of adequate information on health care resource allocation and utillisation. Appropriate studies in these areas are required and consideration should be given to unifying the planning and management of all hospital resources.
本研究利用已发表的数据,按“种族”、地理区域、医院类型(学术型、专科型、综合型或其他)以及所有权性质(如国有、营利性),分析了1983年南非医院及病床的分布情况。结果发现,医院及病床的分布存在不公平现象。总体病床比例为每150名白人拥有一张病床,而每260名黑人/亚洲人/有色人种才有一张病床。按地理区域划分的病床分布情况为:城市白人每130人拥有一张病床,农村白人每260人拥有一张病床,城市黑人/亚洲人/有色人种、农村非“家园”地区的黑人/亚洲人/有色人种以及“家园”地区的黑人/亚洲人/有色人种分别为每150人、460人和300人拥有一张病床。这些差异既无效率又不公平,应定期记录以促使其缩小。需要持续收集卫生服务使用者的人口群体信息,以监测“种族”差异的变化。对所有权和类型分布的分析表明,只有公共部门能够为全体人口提供各级护理平衡适当的医院服务;但在该部门内部,三级护理的主导地位需要重新审视。该研究突出了医疗保健资源分配和利用方面缺乏充分信息的问题。需要在这些领域开展适当研究,并应考虑统一所有医院资源的规划和管理。