医疗卫生资源是保障人民群众生命健康的重要资源。如何公平、科学、合理 地配置医疗卫生资源，是关系到卫生事业发展和全面建成小康社会的重要 课题， 也是能否满足人民群众日益增长的美好生活需求的重要问题。因此，不断完善医 疗卫生资源配置体系，优化资源配置手段，是当前医疗卫生资源配置研究的重点。 天津市 位于渤海之滨，是我国北方经济中心和国际港口城市，也是新确立的 国家中心城市之一。城市居民健康水平作为衡量城市社会发展水平的重要指标， 与城市医疗卫生资源的整体 配置状况有着密不可分的关系。当前，天津市医疗卫 生资源配置还存在着区域分布不均衡，政策依赖性较强，市场环境适应能力差； 基层医疗机构职能弱化，医师多点执业制度 推行力度不够；市场化手段运用不足， 供需矛盾未得到有效解决；机构配套基础设施不完善，严重限制服务能力和资源 配置效率提升等一系列问题。 本文结合天津市医疗卫生资 源配置的现状，以《天津市卫生计生统计年鉴》 数据资料和问卷调查相关资料为基础，采用文献研究法、描述性研究法、数据分 析方法和问卷调查法，对天津市医疗卫生资源分 布的特点和存在问题进行分析。 根据天津市医疗卫生资源配置存在的突出问题和国内外医疗卫生资源配置的有 关经验，提出天津市医疗卫生资源市场化配置的内外部需求。同时 ，运用SWOT 分析方法对天津市医疗卫生资源市场化配置进行分析，结合对天津市医疗卫生资 源进行市场化配置的影响因素，分析指出关于天津市医疗卫生资源市场化配置的 对策 建议，为进一步完善天津市医疗卫生资源配置体系，促进社会资本办医和医 师多点执业制度推行，加快建设“健康天津”打下坚实基础。 关键词：医疗卫生资源，市场化，配置 II ABSTRACT Medical and health resources are important resources to protect people's life and health. How to allocate medical and health resources fair, scientifically and reasonably is related to the health development and important task to build a well-off society, and the important issues which can satisfy people's growing demand for a better life. Therefore, continuous improvement of the medical and health resource allocation system and the optimization of resource allocation means is the emphasis of the current research on the allocation of medical and health resources. Tianjin is near the BoHai Sea, which is the north economic center and the international port city, and is also one of the newly established central cities. As an important indicator to measure the level of urban social development, the health level of urban residents is closely related to the overall allocation of urban medical and health resources. At present,the distribution of medical and health resources in Tianjin is unevenly distributed, with strong policy dependence and relatively concentrated quality medical and health resources. The function of primary medical institutions is weakened, and the system of graded diagnosis and treatment is insufficient. The lack of marketization means and the contradiction between supply and demand has not been solved effectively; The facilities are imperfect and the service capacity is severely restricted. In this paper, combining the current situation of the Tianjin medical and health resources allocation, using the and questionnaire survey as the basis, using literature study, descriptive study, data analysis method and questionnaire survey, the characteristics of the medical and health resources distribution and problems in Tianjin is analyzed, according to the main problems of medical and health resources in Tianjin on the configuration of the marketization and the related experience both at home and abroad, puts forward the necessity of marketization of medical and health resources allocation in Tianjin. At the same time, the SWOT analysis method is used to analyze the market-oriented allocation of medical and health resources in Tianjin, combining with the influence factors to analysis and show the countermeasures for the marketization, in order to III further improve the Tianjin medical and health resources allocation system, promote the grading system, to lay a solid foundation to speed up the construction of "Health Tianjin". KEY WORDS: Medical and Health Resources, The Marketization ,Configuration IV 目 录 目 录 ................................................................................................................................................ IV 第1章 绪 论 ..................................................................................................................................... 1 1.1 研究的背景和意 义 ................................................................................................................... 1 1.1.1 研究背景 ....................................................................................................................... 1 1.1.2 研究意义 ....................................................................................................................... 2 1.2 研究方法与研究框架 ............................................................................................................... 3 1.2.1 研究方法 ..................................................................................................................... 3 1.2.2研究框架 ...................................................................................................................... 4 1.3 研究内容 ................................................................................................................................... 4 1.4 研究中的创新与不足 ............................................................................................................... 5 第2章 医疗卫生资源配置的理论基础与研究综述 ........................................................................ 7 2.1 医疗卫生资源配置的理论基础 ............................................................................................... 7 2.1.1相关概念 ........................................................................................................................ 7 2.1.2理论基础 ........................................................................................................................ 8 2.2 国内外关于医疗卫生资源配置的研 究 ................................................................................. 11 2.2.1 国内有关研究综述 ..................................................................................................... 11 2.2.2 国外有关研究综述 ..................................................................................................... 13 2.2.3 文献评述与启示 ......................................................................................................... 15 第3章 天津市医疗卫生资源配置的现状与问题 .......................................................................... 17 3.1 天津市医疗卫生资源现状 ..................................................................................................... 17 3.1.1现有资源概述 .............................................................................................................. 17 3.1.2资源分布状况 .............................................................................................................. 19 3.2天津市医疗卫生资源利用效率及配置差异分析 .................................................................. 24 3.2.1天津市医疗卫生资源利用效率分析 .......................................................................... 24 3.2.2天津市医疗卫生资源配置差异分析 .......................................................................... 27 3.3天津市医疗卫生资源配置存在问题 ..................................................................................... 29 3.3.1过度依赖政策导致市场适应能力差 .......................................................................... 30 3.3.2基层机构弱化导致多点执业进展缓慢 ...................................................................... 31 3.3.3市场供需矛盾依然突出 .............................................................................................. 32 3.3.4配套设施不完善制约资源配置效率提升 ........................................................