深化医药卫生体制改革——优化突发公共卫生事件下医疗资源配置新进展

徐婷; 徐洁; 张录法; 王韬; 董恩宏

doi:10.16766/j.cnki.issn.1674-4152.001987

深化医药卫生体制改革——优化突发公共卫生事件下医疗资源配置新进展

doi: 10.16766/j.cnki.issn.1674-4152.001987

徐婷^{1, 2},
徐洁³,
张录法^{4, 5},
王韬⁶,
董恩宏^{1, 2, ,}

1.
上海健康医学院护理与健康管理学院，上海 201318
2.
上海交通大学媒体与传播学院医学传播研究中心，上海 200240
3.
德州市人民医院急诊科，山东德州 253014
4.
上海交通大学国际与公共事务学院，上海 200030
5.
上海交通大学健康长三角研究院，上海 200030
6.
同济大学附属东方医院应急管理中心，上海 200120

基金项目:

国家社科基金重大项目 18ZDA088

国家社科基金一般项目 19BGL246

国家社科基金一般项目 18BGL242

详细信息

通讯作者:
董恩宏, E-mail: kevin8012@126.com

中图分类号: R197 R184
计量
- 文章访问数: 131
- HTML全文浏览量: 59
- PDF下载量: 10
- 被引次数: 0
出版历程
- 收稿日期: 2020-12-24
- 网络出版日期: 2022-02-16

Deepen the reform of the medical and health system: Optimize new progress in the allocation of medical resources under sudden public health incidents

XU Ting^{1, 2},
XU Jie³,
ZHANG Lu-fa^{4, 5},
WANG Tao⁶,
DONG En-hong^{1, 2
, ,}

1.
School of Nursing and Health Management, Shanghai University of Medicine & Health Science, Shanghai 201318, China

摘要

摘要: 本文简述医疗资源的内涵及其配置要素，对国内外突发公共卫生事件下医疗资源配置研究的现状和进展进行梳理和评述。评述主要从应急资源配置规则、应急管理流程和评估、医疗资源需求量测算、医疗人力、机构、设备、物资和内外部管理等方面进行，提出现有国内外研究存在的问题和不足，包括：(1)对突发公共卫生事件应急管理法律、规则和制度、应急管理常态化流程等体制机制设计的研究没有充分结合各国实际卫生体制考虑；(2)具体对应急场景与医疗资源配置衔接的相关研究较少；(3)我国研究应急医疗资源配置的方法比较有限，大多以定量研究的方法集中在医疗机构选址和应急物资优化配置上，而在突发公共卫生事件场景下如何进行医疗资源种类的确定等方面鲜有涉及。基于以上梳理，提出进一步的研究方向，包括：(1)结合本国国情，开展突发公共卫生事件下应急法律法规及规则流程的相关研究；(2)结合现有卫生体制改革，进行医疗资源配置策略的相关研究；(3)结合具体测算方法，进行医疗资源种类确定、配置要素的优先排序、医疗人财物资源需求测算的研究。
- 突发公共卫生事件 /
- 医疗资源 /
- 配置 /
- 进展
Abstract: This article briefly describes the connotation and allocation elements of medical resources, and reviews the current status and progress of medical resource allocation researches in public health emergency at home and abroad. The review is mainly from the resource allocation rules, emergency management process and evaluation, measurement of medical resources demand, medical human resource, institutions, equipment, supplies and internal and external management, then addresses the limitations of existing researches are as follows: (1) The research on the design of emergency management laws, rules and systems, emergency management normalization process and other institutional mechanisms of public health emergencies is not fully combined with the actual health system of various countries. (2) There are few researches on the connection between specific emergency scenarios and medical resource allocation. (3) The research methods of emergency medical resource allocation in China are relatively limited, most of which focus on the location of medical institutions and the optimal allocation of emergency materials by quantitative research methods. However, there is little discussion on how to determine the types of medical resources in the case of public health emergencies. Based on the above analysis, further research directions are proposed: (1) The formulation of emergency laws, regulations and procedures on medical resource allocation in public health emergency with full consideration of specified health system features for every country. (2) Combined with the existing health system reform, the related research of medical resource allocation strategy was carried out. (3) The determination of the types and prioritization of medical resources, and more uses of methods to compute medical human resource, material resources, financial resources, equipment and other resources needed in public health emergency.
- Public health emergency /
- Medical resources /
- Allocation /
- Progress

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参考文献(39)

[1]	王俊豪, 贾婉文. 中国医疗卫生资源配置与利用效率分析[J]. 财贸经济, 2021, 42(2): 20-35. doi: 10.3969/j.issn.1002-8102.2021.02.003
[2]	丁雪莹, 卢真. 关于突发公共卫生事件中医疗资源应急配置原则的思考——新冠肺炎疫情中湖北省调配实践的反思[J]. 经济研究参考, 2020, 12(15): 46-57. https://www.cnki.com.cn/Article/CJFDTOTAL-JJCK202015004.htm
[3]	张人杰, 李娜, 戚小华, 等. 浙江省区域公共卫生应急能力与资源配置公平性分析[J]. 中国公共卫生, 2020, 36(5): 775-779. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW202005027.htm
[4]	LIU H, LIU Y. Construction of a medical resource sharing mechanism based on blockchain technology: Evidence from the medical resource imbalance of China[J]. Healthcare, 2021, 9(1): 52-68. doi: 10.3390/healthcare9010052
[5]	SONMEZ T, PATHAK A, VNVER M, et al. Categorized priority systems: A new tool for fairly allocating scarce medical resources in the face of profound social inequities[J]. Chest, 2020, 3(22): 1294-1299. http://www.sciencedirect.com/science/article/pii/S0012369220355021
[6]	MUSCATELLO J, MCINTYRE B. Comparing mortalities of the first wave of coronavirus disease 2019 (COVID-19) and of the 1918-19 winter pandemic influenza wave in the USA[J]. Int J Epidemiol, 2020, 49(6): 2089-2091. http://academic.oup.com/ije/article/49/6/2089/5905673
[7]	SHAHIL A, AKBER N, AKBER N, et al. Impact of the COVID-19 pandemic on mental health and well-being of communities: An exploratory qualitative study protocol[J]. BMJ Open, 2020, 10(12): 1-4. doi: 10.1136/bmjopen-2019-033457corr1
[8]	YU Y, ZHANG Z H, SUN R J, et al. AI-guided resource allocation and rescue decision system for medical applications[J]. Future Gener Comp Sy, 2021, 118(5): 485-491. http://www.sciencedirect.com/science/article/pii/S0167739X20330727
[9]	JIE L, LIANG G, JI J, et al. Emergency material allocation with time-varying supply-demand based on dynamic optimization method for river chemical spills[J]. Environ Sci Pollut R, 2018, 25(18): 17343-17353. doi: 10.1007/s11356-018-1489-1
[10]	KRISTA H, HOLLY A, TAYLOR W, et al. Action guide for addressing ethical challenges of resource allocation within community-based healthcare organizations[J]. J Clin Psy CHIAT, 2018, 29(2): 343-383. http://europepmc.org/abstract/MED/29916829
[11]	ROSENFELD E L, BINDER S, BRUSH C A, et al. National public health institute legal framework: A tool to build public health capacity[J]. Pub Med, 2020, 18(S1): 189-198 http://www.researchgate.net/publication/338959060_National_Public_Health_Institute_Legal_Framework_A_Tool_to_Build_Public_Health_Capacity
[12]	SARAH P, TURNER S, RAMSAY A, et al. School-based vaccination programmes: A systematic review of the evidence on organization and delivery in high income countries[J]. BMC Public Health, 2017, 17(1): 291-295. doi: 10.1186/s12889-017-4196-9
[13]	NWIZU M, DOWNS T, KRIZO J, et al. 173 Trauma activations are associated with decreased time to diagnosis & treatment of intracerebral hemorrhage when compared to trauma evaluations[J]. Ann Emerg Med, 2020, 76(4S): S67-S67.
[14]	LUOURENCO J, MELANCIA D, GODINHO F, et al. Neurologists' diagnostic accuracy and interspecialties' diagnostic concordance of acute rertigo: Observational study at the emergency department in a tertiary center[J]. Neurologist, 2021, 26(2): 36-40. doi: 10.1097/NRL.0000000000000324
[15]	MIYU U, TAKAFUMI M, MASUKO T, et al. Repetitive episodic isolated vertigo in a patient with cerebellar Infarction[J]. J Stroke Cerbrovasc, 2019, 28(7): e98-e99. doi: 10.1016/j.jstrokecerebrovasdis.2019.03.051
[16]	KUM Y, SEAN S, WEI L, et al. Managing emergency department crowding through improved triaging and resource allocation[J]. Oper Res Health C, 2016, 10(3): 13-22. http://www.sciencedirect.com/science/article/pii/S221169231420035X
[17]	KAIN T, FOWLER R. Preparing intensive care for the next pandemic influenza[J]. Critical care, 2019, 23(1): 1-9. doi: 10.1186/s13054-018-2293-5
[18]	WU S S, WEI Z H, GREENE C M, et al. Mortality burden from seasonal influenza and 2009 H1N1 pandemic influenza in Beijing, China, 2007-2013[J]. Influenza Other Resp, 2018, 12(1): 88-97. doi: 10.1111/irv.12515
[19]	MANDAL S, BHATNAGAR T, ARINAMINPATHY N, et al. Prudent public health intervention strategies to control the coronavirus disease 2019 transmission in India: A mathematical model-based approach[J]. Indian J Med Res, 2020, 151(2-3): 190-199. http://www.researchgate.net/publication/340100532_Prudent_public_health_intervention_strategies_to_control_the_coronavirus_disease_2019_transmission_in_India_A_mathematical_model-based_approach
[20]	WILCOX B A, AGUIRRE A A, PAULA N, et al. Operationalizing one health employing social-ecological systems theory: Lessons from the greater Mekong sub-region[J]. Front Public Health, 2019, 22(7): 85-89. http://www.researchgate.net/publication/333258071_Operationalizing_One_Health_Employing_Social-Ecological_Systems_Theory_Lessons_From_the_Greater_Mekong_Sub-region
[21]	SAMBALA E Z, KAYENDA T, IWU C J, et al. Pandemic influenza preparedness in the WHO African region: Are we ready yet?[J]. BMC Infect Dis, 2018, 18(1): 1-3. doi: 10.1186/s12879-017-2892-9
[22]	MELMER P, CARLIN M, CASTATER C, et al. Mass casualty shootings and emergency preparedness: A multidisciplinary approach for an unpredictable Event[J]. J Multidiscip Health, 2019, 12: 1013-1021. doi: 10.2147/JMDH.S219021
[23]	YASMIN K, TRACEY O S, ADALSTEINN B, et al. Public health emergency preparedness: A framework to promote resilience 11 medical and health sciences 1117 public health and health services[J]. BMC Public Health, 2018, 18(1): 1344. doi: 10.1186/s12889-018-6250-7
[24]	何兰萍, 王晟昱. 主体合作与资源可及: 慈善组织参与医疗救助的路径——基于135个案例的比较分析[J]. 中国第三部门研究, 2020, 20(2): 69-93, 200.
[25]	钟淑馨, 曹晓翼, 蒋艳, 等. 新型冠状病毒肺炎紧急救治下护理人力资源调配方案实施及效果[J]. 中国护理管理, 2020, 20(2): 226-229. doi: 10.3969/j.issn.1672-1756.2020.02.016
[26]	贾静. 供应链突发事件应急能力提升机制研究[J]. 物流工程与管理, 2015, 37(7): 131-133. doi: 10.3969/j.issn.1674-4993.2015.07.046
[27]	陈佳梁. 多灾害点应急物资储备体系网络研究[D]. 北京: 北京邮电大学, 2017.
[28]	张远平, 蔡琳玲, 李海默. 疫情下公共卫生防控应急体系建设的反思[J]. 中国医院建筑与装备, 2020, 21(6): 21-24. https://www.cnki.com.cn/Article/CJFDTOTAL-YYJZ202006009.htm
[29]	钱洪伟, 梅京兰. 中国自然灾害区域应急救援中心布局设计研究[J]. 灾害学, 2020, 35(2): 194-199. doi: 10.3969/j.issn.1000-811X.2020.02.035
[30]	EMANUEL E J, PERSAD G, UPSHUR J, et al. Fair allocation of scarce medical resources in the time of Covid-19[J]. New Engl J Med, 2020, 47(1): 3-6. http://www.ncbi.nlm.nih.gov/pubmed/32202722?utm_source=research-news&utm_medium=referral&utm_campaign=research-news
[31]	戚孝娣. 基于Pso-NIW的突发事件城际应急物资调配模型研究[D]. 南京: 东南大学, 2017.
[32]	李维安, 张耀伟, 孟乾坤. 突发疫情下应急治理的紧迫问题及其对策建议[J]. 中国科学院院刊, 2020, 35(3): 235-239. https://www.cnki.com.cn/Article/CJFDTOTAL-KYYX202003003.htm
[33]	胡晓伟, 宋浪, 杨滨毓. 重大突发公共卫生事件下城市应急医疗物资优化调度研究[J]. 中国公路学报, 2020, 33(11): 55-64. doi: 10.3969/j.issn.1001-7372.2020.11.007
[34]	詹沙磊, 傅培华, 李修琳, 等. 基于马尔可夫决策的应急物资动态分配模型[J]. 控制与决策, 2018, 33(7): 1312-1318. https://www.cnki.com.cn/Article/CJFDTOTAL-KZYC201807023.htm
[35]	刘珊珊. 应急物资动态优化调度问题研究[D]. 济南: 山东师范大学, 2016.
[36]	刘家国, 孔玉丹, 周欢, 等. 供应链风险管理的物理-事理-人理方法研究[J]. 系统工程学报, 2018, 33(3): 298-307. https://www.cnki.com.cn/Article/CJFDTOTAL-XTGC201803002.htm
[37]	朱敏, 叶凌凌, 王静, 等. 地市级医疗机构突发公共卫生事件科研应急管理机制建设: 以新冠肺炎疫情防控为例[J]. 中华医院管理杂志, 2020, 36(10): 826-828. doi: 10.3760/cma.j.cn111325-20200713-01622
[38]	魏娜, 王焕. 突发公共卫生事件下应急志愿服务体系与行动机制研究[J]. 南通大学学报(社会科学版), 2020, 36(5): 71-80. doi: 10.3969/j.issn.1673-2359.2020.05.010
[39]	胡智鹏, 李瑶, 宋绍成, 等. 突发公共卫生事件大数据分析与防控策略研究[J]. 情报科学, 2020, 38(11): 104-109. https://www.cnki.com.cn/Article/CJFDTOTAL-QBKX202011017.htm