سنجش تمركز فضايي و نابرابري منطقه اي در زيرساخت هاي حوزه بهداشت و درمان (رهيافت ناپارامتريك)

Horizontal measuring regional disparities in the health infrastructure ( nonparametric approach )

يكي از اهداف اصلي آمايش سرزمين و برنامه ريزي كلان توسعه كشور، تأكيد بر گسترش زيرساخت هاي حوزه بهداشت و درمان در فضاي جغرافيايي و تخصيص يابي منطقه اي است. عدالت در بخش بهداشت و سلامت به معناي آن است كه همه افراد يك جامعه به صورت يكسان از منابع و امكانات بهداشتي برخوردار باشند. هر چه توزيع ميزان و سطح شاخصهاي بهداشتي در يك جامعه بيشتر و مناسبتر باشد سلامتي و رفاه بيشتري را براي آن جامعه به همراه خواهد داشت. اين مقاله، به سنجش فضايي و نابرابر ي منطقه اي زيرساختهاي بهداشت و درمان در سال 1392 در بين استانهاي كشور مي پردازد . روش تحقيق از نظر هدف، كاربردي و از حيث روش كمي- تحليلي است كه از شاخصهاي نسبت تمركز فضايي kاستان برتر، شاخص هرفيندال- هيرشمن، هال- تايدمن، شاخص جامع تمركز منطقه اي، هانا- كاي و آنتروپي در توزيع منطقه اي بيمارستانهاي خصوصي، دولتي و تعداد تختهاي فعال در استانهاي كشور استفاده شده است. براساس يافته هاي اين پژوهش متوسط تمركز فضايي چهار استان برتر 44,40 ميباشد كه نشان دهنده وجود تمركز فضايي و نابرابري منطقه اي پايين در زيرساختهاي حوزه بهداشت و درمان در بين استان هاي كشور بوده و بيشترين سهم را در تمام شاخصهاي حوزه بهداشت و درمان استان تهران دارد.

Extended Abstract Introduction Hospitals are the most important and complex social units which are intended to protect the lives of people and to treat and improve them. With the passage of time and progress in science, hospitals have been equipped with more advanced technology and facilities. More active beds in hospitals are indications of specialized manpower, equipment and facilities for the patients, diagnosis of diseases and other services in this regard. In this study, we investigated the distribution of hospitals and active beds in Provinces of Iran. Theoretical Framework The spatial concentration of active beds of the hospitals of each Iranian province in 2013 was computed using absolute concentration indices, i.e., concentration ratio of K top provinces, Herfindahl Hirschman Index (HHI), Hall Taydmn Index (HTI), Comprehensive Index of Regional Concentration, Hanna Kai Index and Entropy. Methodology To calculate the concentration ratio of K provinces, the sum of share of K largest provinces should be calculated. For Herfindahl Hirschman Index, the share of the sum of the square of province size is considered the share of that province. According to this relationship, provinces with greater shares are given more weight. The Comprehensive Index of Regional Concentration was introduced by Hurat (1970) to overcome the inefficiencies of previous indices. Using this index, it is possible to simultaneously calculate the relative distribution of the share of each province and its absolute size. In Hanna Kai Index, two parameters, i.e., sensitivity and the specific value of market share are used to illustrate the view of the researcher as to the changes in the concentration caused by the entrance and exit of provinces and the share of facilities among the Provinces of Iran. The value of Entropy Index has an inverse relation with the degree of spatial concentration. If the whole share is for one province, the value of the index approaches zero. When the shares of all the provinces are equal, the value of the index will be maximized. Results Discussion Calculating the concentration index of k top provinces, we figured out that spatial concentration of active hospital beds are low regarding that the share of 4 top provinces is about 40 percent of Iran. The value of Herfindahl equals 834.852 this index can be used to conclude that the spatial concentration of the number of active beds in Provinces of Iran are low. The value of Comprehensive Index of Regional Concentration is 0.2892. Because this value is near zero, there is a low concentration in the number of active beds in Provinces of Iran. The value of Hanna Kai Index is 9.916 when =2.5. The value of Entropy Index is 4.289. This index has an inverse relation with the degree of spatial concentration. It can be stated that the concentration of active beds in Provinces of Iran is low according to Entropy Index. Conclusion and Suggestions The ratio of spatial concentration of four top provinces, Comprehensive Index of Regional Concentration and Entropy Index are 44 %, 834, 0.062, 0.29 and 4.289 respectively. In addition, Hanna Kai Index for α=0.6, α=1.5 and α=2.5 is 23.86, 15.12 and 9.91 respectively. Regarding the obtained results from these indices, it can be stated that there is a low concentration in the distribution of the number of active beds in Provinces of Iran and that active beds are distributed in the provinces in a relatively appropriate manner. Taking population into consideration, regional inequality is low in Provinces of Iran regarding the distribution of active hospital beds.