农村公共医疗设施服务质量均等化与优化研究

Public health care service, as an important part of the public goods supply in China, is the stable and persistent demand that farmers’ need, which means that it is the core of the Healthy China strategy development. However, the rural public medical facilities in China are facing the problem of the imbalance in the quality of service supply. Under this situation, their service quality equalization become a significant index to increase the sense of gain for the rural residents, and the utilization efficiency of medical resources is the value orientation of sustainable development of health care service. In our previous research, we found that the impact of distance cost and space accessibility on residents' medical behavioral preferences was reduced. The service quality becomes the focus of attention because of the increasing health needs. There have been some new features and patterns formed between medical facilities service area and its hierarchy..Accordingly, this project, which focus on the main rural areas in the representative counties of Hubei province, is concentrating on the service quality of public medical facilities in rural areas, taking the administrative villages as basic spatial units. It will found a spatial matching model on supply and demand of rural medical service in a multi-scale by using the geographimetrics and geovisulization method. .(1)This project, which is different from the traditional equalization evaluation method that taking traffic accessibility as the main index, chooses the level of service quality equalization in rural medical facilities to reflect equity, and taking account of the evaluation of utilization efficiency of medical resources. The above methods are to explore the spatial differentiation of service quality equalization and utilization efficiency, and thus to detect the surplus and shortage areas of equity and efficiency..(2)According to the changes in rural population and preference demand, targeting to the maximization of the output of public medical resources, oriented by equity and efficiency, taking the service quality and utilization efficiency as the key index, the project will carry out optimization simulation of medical resource allocation, and thus provide scientific theory and tools to rural health care spatial planning.

公共医疗服务作为我国公共物品供给的重要组成部分，是农户持续稳定且迫切的需求，是健康中国战略发展的核心。在当今中国农村公共医疗设施服务供给质量失衡情况下，医疗设施服务质量均等化成为提升当代农村居民获得感的指标，医疗资源的使用效率成为医疗可持续发展的价值取向。前期研究发现，距离成本和空间可达对居民就医偏好影响降低，服务质量成为关注重点，医疗设施服务区与等级体系形成新的规律和模式。据此本项目选择湖北省代表县域，以农村公共医疗设施的服务质量为研究对象，建立农村医疗服务供需匹配模型。（1）区别于交通可达性为主的传统均等化评价，选择农村医疗设施服务质量均等化水平来体现公平，同时兼顾评估医疗资源的利用效率，识别公平与效率盈缺区。（2）以公共医疗资源产出最大化为目标，以公平和效率为导向，以服务质量与利用效率为关键指标，以农村人口和偏好需求变化为依据，开展资源配置优化模拟，为农村医疗空间规划提供参考和依据。

公共医疗服务作为我国公共物品供给的重要组成部分，是农户持续稳定且迫切的需求，是健康中国战略发展的核心。在当今中国农村公共医疗设施服务供给质量失衡情况下，医疗设施服务质量均等化成为提升当代农村居民获得感的指标，医疗资源的使用效率成为医疗可持续发展的价值取向。据此本项目选择湖北省代表县域，以农村公共医疗设施的服务质量为研究对象，建立农村医疗服务供需匹配模型。（1）透过具体的实证研究和具体的案例实验来解释农村基本医疗服务质量在时间序列上的发展变化趋势和空间上的分异规律。在构建公共医疗资源效率指标体系的基础上，通过效率评价模型和空间分析模型来揭示案例区公共医疗资源的配置差异和效率特征；（2）通过引入微观个体的理性选择因素、宏观的绩效与价值因素作为制约基本公共服务质量目标的内在约束与外部条件，着眼于考察农村基本医疗服务质量的满意度及其影响机制，发现满意度存在城乡差异的逻辑；从医疗服务便捷度、医疗服务资产设备、医疗服务供给能力、医疗服务满意度、医疗服务应急能力、医疗服务需求状况等不同层面分析农村基本医疗服务质量的综合水平，并从经济社会发展、资源供给、居民行为、公共政策四个角度来探讨医疗服务质量形成空间分异的机制。（3）以公共医疗资源产出最大化为目标，以公平和效率为导向，以服务质量与利用效率为关键指标，以农村人口和偏好需求变化为依据，开展资源配置优化模拟，为农村医疗空间规划提供参考和依据。