中国居民健康水平的区域差异:2003-2013

doi:10.11821/dlxb201704010

摘要/Abstract

摘要：

健康不公平作为影响人类发展的核心问题,已引起世界各国的广泛关注。基于变异系数、泰勒指数、空间自相关分析和空间面板计量模型,本文探讨了2003年以来中国居民健康水平的区域差异、时空变化及其关键影响因素,旨在为政府制定全民健康政策提供科学依据。结果发现：① 2003-2013年,中国居民健康水平提高26.98%,西部增幅高于东、中部,但始终保持着“东—中—西”阶梯式递减态势;② 中国居民健康水平的区域差异总体呈扩大趋势,其中地带间差异趋于缩小,地带内差异趋于扩大,西部地带内差异扩大尤为显著;③ 居民健康水平的空间分布转为明显的“T”字型格局,并呈“东—中—西”阶梯式及“北—中—南”对称式递减;④ 居民健康水平的空间集聚程度趋于减小,热点区与冷点区均呈收缩态势,且西部形成规模显著的稳定性冷点,东部沿海形成规模显著的稳定性热点;⑤ 人均GDP、人均公共医疗卫生支出、城市化水平及环境质量等因素对居民健康水平时空变化具有显著影响,随着人均GDP与人均公共医疗卫生支出的增加、城市化水平的提高及环境质量的改善,居民健康水平随之提高。未来,还需对居民健康水平的多时域、多尺度及多影响机制等问题开展深入研究。

关键词: 居民, 健康水平, 区域差异, 影响因素, 中国

Abstract:

As one of the core problems clsoely related with human development, health inequality has aroused an increasing concern in the world. Through an integration of the coefficient of variation, Theil index, exploratory spatial data analysis (ESDA) and spatial panel econometric model, we examine the regional inequality, spatial-temporal dynamic patterns and the key factors of the residents' health level (RHL) in China from 2003 to 2013. The aim is to provide scientific basis for policy making on regional health inequality reduction in China. The results are shown as follows: (1) China's RHL index decreased from 0.404 to 0.295 in 2003-2013, with an annual rate of 2.698%. Specifically speaking, the growing rate in the western region was higher than that in the eastern and central regions, but the there is no change in RHL in terms of the basic pattern which decreases from the east to central part then to the west. (2) The regional inequality of RHL presented an extending trend in 2003-2013. Among this, the RHL inequality between regions presented a reducing trend, but that within a region presented an expanding trend. And the growing rate of inequalities of RHL in the western region was higher than that of the eastern and central regions. (3) The spatial distribution of RHL has tended into the letter "T" shape, and the RHL presented a stepped decrease from the east to the central part then to the west and a symmetric decrease from the north to the central part then to the south. (4) By observing the change of Moran's I in 2003, 2008 and 2013, we found that the spatial agglomeration range of RHL presented a narrowing trend. All the hot spots and cold spots presented a shrinking tendency, the RHL in the west formed a stable cold spot, including Xinjiang, Qinghai and Xizang, but that in the east coastal area formed a stable hot spot, including Shandong, Henan, Qinghai, Hubei, Anhui, Jiangsu and Shanghai. (5) The selected explanatory variables, such as per capita GDP, per capita spending on health, urbanization level and environment quality, have significant direct impacts on the RHL in China. With the increase of per capita GDP, per capita spending on health and urbanization level and the improvement of environment quality, the RHL will be raised. Finally, this paper points out the attention should be focused on the research of the regional inequality of RHL, such as the problems of the residents' multi-time-domain, multi-scale and multi-influencing mechanism.

Key words: residents, health level, regional inequality, influencing factors, China

赵雪雁, 王伟军, 万文玉. 中国居民健康水平的区域差异:2003-2013[J]. 地理学报, 2017, 72(4): 685-698.

Xueyan ZHAO, Weijun WANG, Wenyu WAN. Regional inequalities of residents' health level in China: 2003-2013[J]. Acta Geographica Sinica, 2017, 72(4): 685-698.

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变量	2003年	2004年	2005年	2006年	2007年	2008年	2009年	2010年	2011年	2012年	2013年
人均GDP(PGDP)	-0.508^**	-0.486^**	-0.422^**	-0.453^**	-0.441^**	-0.437^**	-0.405^**	-0.425^**	-0.448^**	-0.418^**	-0.413^**
人均公共卫生支出(WSZC)	-0.000	-0.078	-0.190	-0.140	-0.309	-0.218	-0.427^**	-0.498^**	-0.452^**	-0.457^**	-0.454^**
医疗卫生资源可及性(YLCJ)	-0.261	-0.184	-0.104	-0.125	-0.15	-0.132	-0.12	-0.133	-0.112	-0.168	-0.165
城镇化率(CHHL)	-0.489^**	-0.437^**	-0.493^**	-0.537^**	-0.535^**	-0.541^**	-0.522^**	-0.512^**	-0.524^**	-0.550^***	-0.546^***
环境质量指数(HJZL)	-0.500^**	-0.416^**	-0.235	-0.404^**	-0.477^**	-0.370^**	-0.372	-0.178	-0.327^*	-0.251	-0.260

变量	弹性系数	T值	P值	变量	弹性系数	T值	P值
lnPGDP	-0.017^**	-2.39	0.017	W×lnPGDP	-0.037^***	-2.79	0.005
lnWSZC	-0.013^**	-1.98	0.049	W×lnWSCZ	0.003	0.48	0.630
lnYLCJ	-0.054	-1.36	0.174	W×lnYLCJ	0.029^***	2.83	0.005
lnCZHL	-0.129^**	-2.32	0.021	W×lnCZHL	0.093^***	3.40	0.001
lnHJZL	-0.012^**	-2.08	0.035	W×lnHJZL	-0.081^***	3.99	0.000
lnHJZL	-0.012^**	-2.08	0.035	W×lnJKZS	0.030^***	3.51	0.001

	直接效应	P值	间接效应	P值
lnPGDP	-0.018^**	0.038	-0.164^***	0.009
lnWSZC	-0.016^**	0.045	0.009	0.747
lnYLKJ	-0.057	0.180	0.125^**	0.015
lnCZHL	-0.132^**	0.021	0.410^***	0.001
lnHJZL	-0.008^**	0.011	-0.362^***	0.000