中国急救医疗服务需要和利用及资源分布的地区公平性研究

摘要

Background With the increase of aging population,rapid development of industry and increasingly sophisticated transportation networks,the needs for emergency medical services (EMS ) brought by cardiocerebrovascular diseases,disasters and accidents are significantly increased. Objective To analyze the balance of needs and utilization and distribution equity of EMS in China′s (except HongKong,Macao,Taiwan)eastern,central and western regions,and based on this,to put forward suggestions for improving the distribution equity of EMS. Methods We obtained the data of the mortality rates due to circulatory system diseases,injuries and digestive system diseases,emergency visits,utilization rates of EMS, number of emergency medical centers (stations),number of population and size of regions of China during 2010 to 2014 from National Disease Surveillance System Cause-of-death Surveillance and Reporting Database,Chinese Center for Disease Control and Prevention,China′s Health Statistics Yearbook,China Statistical Yearbook. Concentration index (CI)was used to measure the balance of needs and utilization of EMS among different regions. Gini coefficient was employed to describe distribution equity of EMS resources. Results Between 2010 and 2014,the value of CI for the mortality rates due to circulatory system diseases shifted from positive to negative,the value of CI for mortality rate due to injuries (ranged from-0. 1504 to-0. 1241),and that for the mortality rate due to digestive system diseases (ranged from-0. 2279 to-0. 1921)were all negative. The values of CI for the utilization of EMS during 2010 to 2014 were all positive,and it decreased from 0. 1074 to 0. 0824. The Gini coefficient for EMS resources distribution against population size ranged from 0. 0922 to 0. 1200,and that for EMS resources distribution against the size of region ranged from 0. 5481 to 0. 5696,all showed an upward trend generally. Conclusion There is inter-region inequitable distribution of EMS resources. And not all the needs for EMS are met as a result. In view of this,investment of EMS should be increased,emergency vehicle configuration should be enhanced and the professional capabilities of EMS providers should be improved in poor regions.%背景随着人口老龄化程度日益加深、工业和交通运输业的快速发展,心脑血管疾病和各种灾害、事故的急救需求迅速增长.目的 分析我国(不含港澳台)东、中、西部地区间急救医疗服务的需要、利用和资源分布的公平性,提出改善公平性的建议.方法 查阅中国疾病预防控制中心全国疾病监测系统死因监测网络报告数据库、中国卫生统计年鉴、中国统计年鉴,收集2010—2014年我国循环系统疾病、伤害、消化系统疾病死亡率,急诊人次数和急诊利用率、急救中心(站)的数量,人口和区域面积信息.采用集中指数描述地区间急救医疗服务需要、利用是否公平以及公平性程度,以Gini系数描述地区间急救医疗服务资源分布是否公平以及公平性程度.结果 2010—2014年,循环系统疾病死亡率集中指数由正值变为负值,伤害和消化系统疾病死亡率集中指数均为负值,集中指数分别为-0.1504~-0.1241和-0.2279~-0.1921.5年间,急救医疗服务利用的集中指数均为正值,并从0.1074下降到0.0824.从人口公平性角度看,急救医疗服务资源分布的Gini系数为0.0922~0.1200;从区域面积公平性角度看,资源分布的Gini系数为0.5481~0.5696,基本呈升高趋势.结论 我国急救医疗服务存在地区间不公平性,未能满足患者需要.应当从加大经济发展水平低的地区急救医疗投入、完善急救车配置、提高急救医护人员专业素质等方面着手,改善急救医疗服务地区间的公平性.