School of Public Health, Chongqing Medical University, Chongqing, China.
College of Computer Science and Technology, Chongqing University of Posts and Telecommunications, Chongqing, China.
Front Public Health. 2024 Aug 27;12:1369568. doi: 10.3389/fpubh.2024.1369568. eCollection 2024.
This study aimed to evaluate the fairness and efficiency of health resource allocation (HRAE) in Chengdu-Chongqing Economic Circle after the new healthcare reform. This study also aimed to identify existing problems, providing empirical evidence for the government to formulate regional health plans scientifically and reasonably.
The fairness of health resource allocation was analyzed using the Gini coefficient, Theil index, and agglomeration degree from population and geographical area perspectives. The three-stage data envelopment analysis and the Malmquist productivity index were used to analyze HRAE from static and dynamic perspectives.
The Gini coefficient for population allocation in Chengdu-Chongqing Economic Circle was 0.066-0.283, and the Gini coefficient for geographical area allocation was 0.297-0.469. The contribution rate within a region was greater than that between regions, and health resources were mainly concentrated in economically developed core areas. The overall fairness of Chengdu Economic Circle was relatively better than that of Chongqing Economic Circle. Moreover, the adjusted mean technical efficiency was 0.806, indicating room for HRAE improvement in Chengdu-Chongqing Economic Circle. Stochastic Frontier Analysis found that different environmental variables have varying degrees of impact on HRAE. The adjusted mean total factor productivity change (Tfpch) was 1.027, indicating an overall upward trend in HRAE since the new healthcare reform. However, scale efficiency change (Sech) (0.997) limited the improvement of Tfpch.
The fairness of health resources allocated by population was better than that allocated by geographical area. The unfairness of health resources mainly stemmed from intra-regional differences, with considerable health resources concentrated in core areas. Over the past 13 years, HRAE has improved but exhibited spatial heterogeneity and Sech-hindered productivity improvement. The study recommends strengthening regional cooperation and sharing to promote the integrated and high-quality development of the health and well-being in Chengdu-Chongqing Economic Circle.
本研究旨在评估新医改后成渝经济圈卫生资源配置（HRAE）的公平性和效率，为政府科学合理制定区域卫生规划提供依据。
从人口和地理区域两个角度，运用基尼系数、泰尔指数和集聚度分析卫生资源配置的公平性；运用三阶段数据包络分析和 Malmquist 生产率指数从静态和动态两个方面分析 HRAE。
成渝经济圈人口配置的基尼系数为 0.066-0.283，地理区域配置的基尼系数为 0.297-0.469。区域内的贡献率大于区域间的贡献率，卫生资源主要集中在经济发达的核心区域。成都经济圈的整体公平性相对较好，重庆经济圈的公平性相对较差。此外，调整后的平均技术效率为 0.806，表明成渝经济圈的 HRAE 仍有改进的空间。随机前沿分析发现，不同的环境变量对 HRAE 有不同程度的影响。调整后的平均全要素生产率变化（Tfpch）为 1.027，表明自新医改以来 HRAE 呈总体上升趋势。但规模效率变化（Sech）（0.997）限制了 Tfpch 的提高。
人口配置的卫生资源公平性优于地理区域配置的卫生资源公平性。卫生资源的不公平主要源于区域内的差异，相当一部分卫生资源集中在核心区域。过去 13 年来，HRAE 有所改善，但存在空间异质性和 Sech 限制生产力提高的问题。研究建议加强区域合作与共享，促进成渝经济圈卫生与健康的整体协调和高质量发展。
