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医疗保健资源分配的公平性;使用三个实用指标评估需求和可及性

Equity in Distribution of Health Care Resources; Assessment of Need and Access, Using Three Practical Indicators.

作者信息

Omrani-Khoo Habib, Lotfi Farhad, Safari Hossein, Zargar Balaye Jame Sanaz, Moghri Javad, Shafii Milad

机构信息

1. Dept. of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences , Tehran, Iran ; 2. Bushehr University of Medical Sciences , Bushehr, Iran.

3. Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences , Tehran, Iran.

出版信息

Iran J Public Health. 2013 Nov;42(11):1299-308.


DOI:
PMID:26171343
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4499072/
Abstract

BACKGROUND: Equitable distribution of health system resources has been a serious challenge for long ago among the health policy makers. Conducted studies have mostly ever had emphasis on equality rather than equity. In this paper we have attempted to examine both equality and equity in resources distribution. METHOD: This is an applied and descriptive study in which we plotted Lorenz and concentration curves to describe graphically the distribution of hemodialysis beds and nephrologists as two complementary resources in health care in relation to hemodialysis patients. To end this, inequality and inequity were measured by calculating Gini- coefficient, concentration and Robin Hood indices. We used STATA and EXCEL software to calculate indicators. RESULTS: The results showed that inequality was not seen in hemodialysis beds in population level. However, distribution of nephrologists without considering population needs was accompanied with some sort of inequality. Gini- coefficient for beds and nephrologists distribution in population level was respectively 0.02 and 0.38. Hence, calculation of concentration index for distribution of hemodialysis beds and nephrologists with regard to population needs indicated that unlike beds distribution, equity gap between nephrologists distribution against patients distribution among the provinces was considerably significant again. CONCLUSION: Our results imply that although hemodialysis beds in Iran have been distributed in connection with the population need, nephrologists' distribution is not the same as hemodialysis beds one and this imbalance in complementary resources, can affect both efficiency and equitable access to services for population.

摘要

背景:长期以来,卫生系统资源的公平分配一直是卫生政策制定者面临的严峻挑战。以往开展的研究大多侧重于平等而非公平。在本文中,我们试图考察资源分配中的平等与公平情况。 方法:这是一项应用型描述性研究,我们绘制了洛伦兹曲线和集中曲线,以直观描述作为医疗保健中两种互补资源的血液透析床位和肾病专家相对于血液透析患者的分布情况。为此,通过计算基尼系数、集中指数和罗宾汉指数来衡量不平等和不公平程度。我们使用STATA和EXCEL软件来计算各项指标。 结果:结果显示,在总体层面上,血液透析床位的分配不存在不平等现象。然而,未考虑人口需求的肾病专家分布存在某种程度的不平等。总体层面上床位和肾病专家分布的基尼系数分别为0.02和0.38。因此,根据人口需求计算血液透析床位和肾病专家分布的集中指数表明,与床位分布不同,各省肾病专家分布与患者分布之间的公平差距再次相当显著。 结论:我们的结果表明,尽管伊朗的血液透析床位已根据人口需求进行了分配,但肾病专家的分布与血液透析床位的分布不同,这种互补资源的不平衡会影响服务效率和民众获得服务的公平性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/65c9/4499072/a694400323ff/IJPH-42-1299-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/65c9/4499072/88af2dad2f22/IJPH-42-1299-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/65c9/4499072/d024a4108020/IJPH-42-1299-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/65c9/4499072/a694400323ff/IJPH-42-1299-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/65c9/4499072/88af2dad2f22/IJPH-42-1299-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/65c9/4499072/d024a4108020/IJPH-42-1299-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/65c9/4499072/a694400323ff/IJPH-42-1299-g003.jpg

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本文引用的文献

[1]
Equality in Distribution of Human Resources: the Case of Iran's Ministry of Health and Medical Education.

Iran J Public Health. 2013-1-1

[2]
The assessment of inequality on geographical distribution of non-cardiac intensive care beds in iran.

Iran J Public Health. 2011

[3]
The costs in provision of haemodialysis in a developing country: a multi-centered study.

BMC Nephrol. 2011-9-6

[4]
Analysis of inpatient bed allocation equity and utilization in the city community health service center of China.

J Huazhong Univ Sci Technolog Med Sci. 2010-4

[5]
Self-employment, specialty choice, and geographical distribution of physicians in Japan: A comparison with the United States.

Health Policy. 2010-3-11

[6]
Equity of accessibility to dialysis facilities.

Stud Health Technol Inform. 2009

[7]
Dialysis in Iran.

Iran J Kidney Dis. 2008-1

[8]
Measuring inequalities in the distribution of health workers: the case of Tanzania.

Hum Resour Health. 2009-1-21

[9]
Economic burden of chronic kidney disease.

J Eval Clin Pract. 2008-6

[10]
Assessment of management and treatment responses in haemodialysis patients from Tehran province, Iran.

Nephrol Dial Transplant. 2008-1

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