医疗资源和结果不平等威胁埃塞俄比亚的可持续健康发展：面板数据分析。
Inequalities in healthcare resources and outcomes threatening sustainable health development in Ethiopia: panel data analysis.
机构信息
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran (the Islamic Republic of).
School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
出版信息
BMJ Open. 2019 Jan 30;9(1):e022923. doi: 10.1136/bmjopen-2018-022923.
OBJECTIVE
To measure inequalities in the distributions of selected healthcare resources and outcomes in Ethiopia from 2000 to 2015.
DESIGN
A panel data analysis was performed to measure inequalities in distribution of healthcare workforce, infrastructure, outcomes and finance, using secondary data.
SETTING
The study was conducted across 11 regions in Ethiopia.
PARTICIPANTS
Regional population and selected healthcare workforce.
OUTCOMES MEASURED
Aggregate Theil and Gini indices, changes in inequalities and elasticity of healthcare resources.
RESULTS
Despite marked inequality reductions over a 16 year period, the Theil and Gini indices for the healthcare resources distributions remained high. Among the healthcare workforce distributions, the Gini index (GI) was lowest for nurses plus midwives (GI=0.428, 95% CI 0.393 to 0.463) and highest for specialist doctors (SPDs) (GI=0.704, 95% CI 0.652 to 0.756). Inter-region inequality was the highest for SPDs (95.0%) and the lowest for health officers (53.8%). The GIs for hospital beds, hospitals and health centres (HCs) were 0.592(95% CI 0.563 to 0.621), 0.460(95% CI 0.404 to 0.517) and 0.409(95% CI 0.380 to 0.439), respectively. The interaction term was highest for HC distributions (47.7%). Outpatient department visit per capita (GI=0.349, 95% CI 0.321 to 0.377) and fully immunised children (GI=0.307, 95% CI 0.269 to 0.345) showed inequalities; inequality in the under 5 years of age mortality rate increased overtime (P=0.048). Overall, GI for government health expenditure (GHE) was 0.596(95% CI 0.544 to 0.648), and the estimated relative GHE share of the healthcare workforce and infrastructure distributions were 46.5% and 53.5%, respectively. The marginal changes in the healthcare resources distributions were towards the advantaged populations.
CONCLUSION
This study revealed high inequalities in healthcare resources in favour of the advantaged populations which can hinder equal access to healthcare and the achievements of healthcare outcomes. The government should strengthen monitoring mechanisms to address inequalities based on the national healthcare standards.
目的
衡量 2000 年至 2015 年埃塞俄比亚特定医疗保健资源和结果分配的不平等情况。
设计
利用二次数据，通过面板数据分析衡量医疗保健劳动力、基础设施、结果和资金分配的不平等情况。
地点
研究在埃塞俄比亚的 11 个地区进行。
参与者
区域人口和选定的医疗保健劳动力。
测量结果
总体泰尔和基尼指数、不平等变化和医疗资源弹性。
结果
尽管在 16 年期间明显减少了不平等，但医疗资源分配的泰尔和基尼指数仍然很高。在医疗保健劳动力分配中，护士和助产士的基尼指数（GI）最低（GI=0.428，95%置信区间 0.393 至 0.463），专科医生（SPD）的基尼指数最高（GI=0.704，95%置信区间 0.652 至 0.756）。地区间不平等程度最高的是 SPD（95.0%），最低的是卫生官员（53.8%）。病床、医院和保健中心的基尼指数分别为 0.592（95%置信区间 0.563 至 0.621）、0.460（95%置信区间 0.404 至 0.517）和 0.409（95%置信区间 0.380 至 0.439）。保健中心分布的交互项最高（47.7%）。每千人门诊就诊次数（GI=0.349，95%置信区间 0.321 至 0.377）和完全免疫儿童（GI=0.307，95%置信区间 0.269 至 0.345）存在不平等；5 岁以下儿童死亡率的不平等程度随着时间的推移而增加（P=0.048）。总体而言，政府卫生支出（GHE）的基尼指数为 0.596（95%置信区间 0.544 至 0.648），医疗保健劳动力和基础设施分布的估计相对 GHE 份额分别为 46.5%和 53.5%。医疗资源分布的边际变化有利于优势人群。
结论
本研究显示，医疗保健资源存在高度不平等，有利于优势人群，这可能会阻碍平等获得医疗保健和实现医疗保健成果。政府应根据国家医疗保健标准加强监测机制，以解决不平等问题。
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