“看病难，看病贵”是一个长期困扰我国人民就医的问题。“看病难，看病贵”是医疗卫生资源配置不均导致的，医疗卫生资源在大城市综合医院的高度集中与基层社区药品、卫生技术人员的缺失形成鲜明对比，使得大量常见病患者不信任基层医疗设施提供的服务，舍近求远地盲目涌向三级医院，给三级医院的运营造成了极大的负担，由此引发了一系列的社会负面现象。目前，解决医疗问题已经上升为国家政策，医疗改革多次在全国会议上被提及，国家也积极出台了如分级诊疗等多项政策以缓解医疗卫生资源配置不平衡的现状。在新医改的背景下对医疗卫生资源配置的情况进行全面、系统的分析具有迫切性和必要性。

       论文首先介绍了医疗卫生资源配置研究的背景和意义。随后对国内外医疗卫生资源配置的研究成果进行了文献综述研究。在界定本文涉及到的基本医疗卫生资源概念，梳理相关理论的基础上，通过公平性评价和供需匹配优化模型建立了医疗卫生资源配置的研究体系。论文选取西安市作为案例分析的对象，首先从时间维度，描述分析了西安市2009-2016年医疗卫生资源的数量。之后运用修正的资源分布指数和Kakwani指数，从宏观上评价了人口、地理以及经济层面的供给公平性。从空间维度，提出基于服务半径的医疗设施可达性测量方法，评价医疗卫生资源的可达公平性。并在宏观分析的基础上，基于公平性以满意度最大为目标构建供需匹配模型，满意度越高，需求被满足的整体公平程度越好，从微观上对资源使用和患者服务进行指导。最终通过宏观和微观相结合的研究方式，实现资源优化配置和患者满意度的提高。

       研究结果表明：西安市医疗卫生资源的配置总体是比较公平的。以卫生人员、医疗卫生床位数等为代表的医疗卫生资源数量在时间角度上均处于稳中有增的状态。在区域角度上中部拥有的资源量一直处于领先地位，东西部与中部的差距在逐渐缩小，但区县间的公平性较差，配置情况仍存在较大差异。应加强各地区的协同发展，改善卫生资源分布的区县差异和城乡差异；医疗卫生资源的可达方面，在原有两步移动搜寻法的基础上，综合考虑了医院等级和实际交通路网的情况，通过计算得到多种搜索半径，整体的可达性从西北部逐渐向东南部减小；在资源优化配置方面，根据分级诊疗制度的特点，考虑转诊与不转诊两种情况，由医生的实际情况划分医疗组，综合考虑了患者就诊的公平性，计算算例得到了患者满意度较大的资源配置方式。通过西安市医疗卫生资源配置的案例研究，一定程度上为医改政策的制定提供了理论的支撑，为优化资源配置提供了科学的分析方法和参考建议。

“Seeing a doctor is difficult and expensive” is a long-time problem that bother Chinese people.It is caused by the unbalance allocation of medical resources. The difference of medical resources’ amount and level between Tertiary Hospitals and Hierarchical Medical System led to distrust of health service in Hierarchical Medical System, patients with common diseases would like to see a doctor in the Tertiary Hospital no matter how much time and distance costs, which make great burden on the operation, also caused many negative social influence. Nowadays, medical problems have been paid close attention by government, several policies have been published to relief the problem, such as Hierarchical Medical System. Under the background of new medical reform, It is urgent and necessary to make a comprehensive and systematic analysis about the allocation of medical resources.

 

This paper firstly introduced the background of medical resource’s allocation, elaborated the meaning of the study. After summarizing the related study, defining the conception about medical resources, the research system was built by analysis of fairness、supply and demand matching model. In this paper, Xi'an was selected as the object of case analysis. From the macroscopic view, the fairness of supply between regions in Xi'an for the 2009-2016 years were described and analyzed by enhanced index of resource distribution and Kakwani. Then accessibility to health care facilities based on service radius was proposed to evaluate the fairness of accessibility from the spatial view. Based on fairness, the supply and demand matching model is constructed with the goal of maximum satisfaction. The higher the satisfaction is, the better fairness of the demand is satisfied. The model guided the use of resources and patient services from the micro view. In the end, with the combination of macro and micro views, the goal of optimize the allocation、improving use efficiency of resources and satisfaction of patients were achieved.

 

The main results were as follows：The allocation of medical resources in regions is basically fair. The quality of medical resources allocation in Xi'an has gradually improved form the perspective of time. And the amount of health resources has dominated by the central area, the disparity between the central eastern、western regions is narrowing. The coordinated development of various regions should be strengthened to decrease the differences in urban and rural areas. From the view of accessibility, considered the difference of grade and regional distribution characteristics of the hospital, the service radius factors are used to enhance two-step floating catchment area method, The accessibility decreased from northwest to Southeast. According to the characteristics of Hierarchical Medical System, considering the two cases: referral and non-referral, we divide the medical group according to the actual situation of doctors, The fairness of patient was taken into account. The allocation with higher patient satisfaction was finally obtained by calculating the example. The analysis about allocation of Xian’ medical resources provides a theoretical support for the formulation of medical reform policy, also provides a scientific analysis method and reference for optimization.

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