بررسی نابرابری‌های ناحیهای در توسعه خدمات بهداشتی- درمانی (مورد مطالعه: شهرستانهای استان تهران) | ||
| توسعه پایدار محیط جغرافیایی | ||
| مقاله 8، دوره 7، شماره 12، فروردین 1404، صفحه 110-127 اصل مقاله (1.94 M) | ||
| نوع مقاله: پژوهشی | ||
| شناسه دیجیتال (DOI): 10.48308/sdge.2023.232255.1133 | ||
| نویسندگان | ||
| حمیدرضا رخشانی نسب* ؛ محمد حنیف ختار؛ مجتبی سلیمانی دامنه | ||
| گروه جغرافیای انسانی، دانشکده جغرافیا و برنامهریزی محیطی، دانشگاه سیستان و بلوچستان، زاهدان، ایران | ||
| چکیده | ||
| پیشینه و هدف: در جهان معاصر نابرابری‌های منطقه‌ای پدیده‌ای فراگیر و رو به گسترش و مورد توجه برنامهریزی فضایی هستند. یکی از موضوعات مورد تأکید این برنامهریزی، توزیع متعادل خدمات بهداشت و درمان در همه سطوح فضایی است. موضوع برابری در توزیع مناسب این خدمات و اثرگذاری آن بر کمیت و کیفیت تندرستی مردم، سیاستگذاران را به چالش کشیده و اتخاذ سیاست‌های مشخص برای افزایش میزان سلامت و چگونگی توزیع خدمات بهداشتی ضروری است. استان تهران به عنوان مرکز دارای امکانات، سالانه جمعیت زیادی را جذب خود میکند. در این میان شهرستان تهران، جمعیت مهاجر را در خود جذب نمیکند بلکه بیشتر به شهرستانهای حاشیه کشیده میشوند که سبب می شود برخی از شهرستانهای حاشیهای، جوابگوی نیازهای خدمات بهداشتی-درمانی جمعیت نباشند. با توجه به این مهم، هدف پژوهش، بررسی تفاوتهای بین شهرستانهای استان تهران در این زمینه و علت و چرایی آن است. روش‌شناسی: پژوهش حاضر بر اساس هدف کاربردی و روش انجام آن توصیفی تحلیلی است. در این پژوهش اطلاعات و داده‌های مورد نیاز از روش کتابخانهای و مطالعه اسنادی استخراج گردیده است. به این صورت که ابتدا با استفاده از اطلاعات کتابخانهای (کتب، مقالات، اسناد و ....)، بخش مربوط به مقدمه، مبانی نظری و پیشینه پژوهش نوشته شد و در این راستا اطلاعات مربوط به شاخصها، از طریق سالنامه آماری مربوطه جمعآوری شده است. این اطلاعات ابتدا نرمالسازی و با استفاده از تکنیک آنتروپی شانون وزندهی شد. در مرحله بعد با استفاده از تکنیک تصمیمگیری ماباک، شهرستانهای استان تهران از نظر خدمات بهداشتی و درمانی رتبهبندی شدند و در مرحله آخر با توجه به وضعیت هریک از شهرستانها، به علت و چرایی این نابرابریها پرداخته شد. یافته‌ها و بحث: بین شهرستانهای استان تهران از نظر توزیع خدمات بهداشتی و درمانی، تفاوتهای زیادی وجود دارد به گونهای که شهرستان تهران با مقدار 54/123- در رتبه اول، شمیرانات با 72/123-در رتبه دوم، فیروز کوه با 26/125- در رتبه سوم و در سطح توسعه یافته قرار گرفتهاند. شهرستان ورامین با مقدار 87/126- در رتبه چهارم، دماوند با 99/126- دررتبه پنجم، ری با 05/127- در رتبه ششم، پاکدشت با 39/127- در رتبه هفتم، شهریار با 55/127- در رتبه هشتم، پردیس با 56/127- در رتبه نهم و پیشوا با مقدار 81/127- در رتبه دهم و در سطح نیمه توسعهیافته رتبهبندی شدند و نهایتاً شهرستانهای رباط کریم، بهارستان، قرچک، اسلامشهر، ملارد و قدس به ترتیب با مقدارهای، 83/127-، 93/127-، 128-، 2/128-، 18/128- و 22/128- در رتبه 11 تا 16 و در سطح توسعه نیافته قرار گرفتند. شهرستان تهران به علت مرکز و پایتخت بودن، تمامی امکانات از جمله بهداشتی و درمانی (پزشکان متخصص کافی، بیمارستانهای مجهز و با تخت کافی را به طور کامل در اختیار دارد به همین دلیل از نظر خدمات بهداشتی و درمانی توسعه یافته هستند. نتیجه‌گیری: دلیل برخوداری شهرستان تهران از خدمات بهداشتی و درمانی، موقعیت مناسب سیاسی، پایتخت، مرکز بودن و توجه جدی مسئولین امر به این مقوله است که باعث شده متناسب با جمعیت و حتی بیشتر از آن، خدمات بهداشتی و درمانی در این شهرستان فراهم شود و جمعیت آن و حتی از پیرامون (مرکز و جنوب کشور) جهت بهرهمندی از خدمات مناسب به این شهرستان مراجعه کنند. از طرفی دیگر شهرستانهایی مانند شمیرانات، فیروز کوه، دماوند و ورامین و ری با وجود موقعیت نه چندان حساس، به دلیل جمعیت زیاد توانستهاند متناسب با جمعیت خدمات درمانی لازم را فراهم کنند و از امکاناتی مانند بیمارستان چند تختخواب، اورژانسهای مناسب، پزشکان کافی و متخصص و ... بهرهمند شوند. در مقابل شهرستانهایی مانند اسلامشهر، ملارد و پیشوا، فاقد بیمارستان و امکانات لازم مثل پزشک متخصص، ام.آر.آی، سی تی اسکن و ... هستند. به گونهای که جمعیت برای رفع نیازهای درمانی خود به شهرستان اطراف و برخوردار از جمله تهران مراجعه میکنند. نتایج پژوهش، می تواند مسئولین و برنامه‌ریزان کشوری را در امر توزیع متعادل این خدمات به نفع شهرستانهای محروم یاری رساند. | ||
| کلیدواژه‌ها | ||
| خدمات درمانی؛ توزیع ناحیهای؛ نابرابری؛ عدالت اجتماعی؛ استان تهران | ||
| عنوان مقاله [English] | ||
| Review of Regional Inequalities in Development of Health services(Case Study: Counties of Tehran Province) | ||
| نویسندگان [English] | ||
| Hamid-Reza Rakhshaninasab؛ Mohammad Hanif Khatar؛ Mojtaba Soleimani Damaneh | ||
| Department of Human Geography, Faculty of Geography and Environmental Planning, University of Sistan and Baluchestan, Zahedan, Iran | ||
| چکیده [English] | ||
| Background and Purpose: In the contemporary world, regional disparities are widespread and expanding phenomena and are the focus of spatial planning. One of the issues emphasized in this planning is the balanced distribution of healthcare services at all spatial levels. The issue of equality in the proper distribution of these services and its impact on the quantity and quality of people's health has challenged the policy makers, and it is necessary to adopt specific policies to increase the amount of health and how to distribute health services. As a center with facilities, Tehran province attracts a large population every year; in the meantime, Tehran County does not attract the migrant population, but they are mostly drawn to the peripheral counties. This means that some marginal cities do not meet the needs of the health services of the population. Considering this importance, the purpose of the present research is to investigate the differences between the Counties of Tehran province in this regard and the reasons for it. Methodology: The current research is descriptive and analytical, based on its practical purpose and method. In this research, the required information and data have been extracted from the library method and document study. In this way, first, using library information (books, articles, documents, etc.), the section related to the introduction, theoretical foundations, and background of the research was written, and in this regard, the information related to the indicators, through the relevant statistical yearbook, was collected. This information was first normalized and weighted using the Shannon entropy technique. In the next stage, using Mabak's decision-making technique, the Counties of Tehran province were ranked in terms of health services, and in the last stage, according to the situation of each county, the cause and reason of these inequalities were discussed. Findings and Discussion: Among the Counties of Tehran province in terms of the distribution of health and medical services, there are many differences such that Tehran County with -123.54 is in the first place, Shemiranat is in the second place with -123.72, Firouz Koh is in the third place. With -125.26, they are ranked third and at the advanced level. Varamin County with -126/87 in fourth place, Damavand with 126/99 in fifth place, Ray with -127/05 in sixth place, Pakdasht with -127.39 in seventh place, Shahryar with -127.55 in eighth place. Pardis with -127.56 in the ninth place and Pishva with 127.81 in the tenth place, and at the semi-developed level, and finally the Counties of Rabat Karim, Baharestan, Qarchak, Islamshahr, Mallard, and Quds. The values of -127.83, -127.93, -128, -128.2, -128.18, and -128.22 were ranked 11 to 16 and in the undeveloped level. Due to being the center and the capital County of Tehran, it has all the facilities including health and treatment (sufficient specialist doctors, well-equipped hospitals with enough beds). Conclusion: The reason for Tehran County availability of health and medical services is its convenient political location, being the capital, the center, and the serious attention of the authorities to this category, which has made it possible to provide health and medical services in this city in proportion to the population and even more than that and, its population and even from the surrounding (center and south of the country) come to this Countie to benefit from the appropriate services. On the other hand, Counties such as Shemiranat, Firouz Koh, Damavand, Varamin and Ray, despite their not so sensitive location, due to their large population, have been able to provide the necessary medical services according to the population, and from facilities such as multi-bed hospitals, emergency rooms, etc. suitable doctors, sufficient and expert doctors, etc. to benefit. On the other hand, cities such as Islamshahr, Mallard and Pishwa lack hospitals and necessary facilities such as specialist doctors, MRI, CT scan, etc. In such a way that the population goes to the surrounding Counties, such as Tehran, to meet their medical needs. The results of the research can help national officials and planners in the matter of balanced distribution of these services in favor of deprived cities. | ||
| کلیدواژه‌ها [English] | ||
| Medical Services, Regional Distribution, Inequality, Social justice, Tehran Province | ||
| مراجع | ||
|
Abekah-Nkrumah, G., 2019. Trends in utilisation and indequality in the use of reproductive health services in sub-saharan Africa. BMC public health: 19(1),1-15. https://pubmed.ncbi.nlm.nih.gov/31752773/ Alavi, S., Ahmadi, M. and Zar, A., 2017. The relationship between sports activity and social health and spiritual intelligence of nurses, Journal of Social Health, 5 (2), 102-94. https://journals.sbmu.ac.ir/ch/index.php/ch/article/view/16680. (In Persian) Babakhani, M., Ghasemi, S., Rafiei, H., Raghfar, H. and Biglarian, A., 2012. The relationship between distributive justice and health in Iran, Social Welfare, 12 (46), 287-259. https://refahj.uswr.ac.ir/article-1-976-fa.html. (In Persian) Badlivand, M., Karimian, H. and Fathi, S., 2021. The performance of the Social Security Organization in achieving social justice, Iranian Social Development Studies, 13 (2), 52-38. https://jisds.srbiau.ac.ir/article_17774.html. (In Persian) Cai, J., Coyte, P.C. and Zhao, H., 2017. Decomposing the Causes of Socioeconomic - related Health Inequality among Urban and Rural Populations in China: a new decomposition approach, International journal for equity in health: 16(1), 128. https://www.sciencedirect.com/science/article/pii/S2352827322003044 Cleophas, C., Cottrill, C., Ehmke, J. F. and Tierney, K., 2019. Collaborative urban transportation: Recent advances in theory and practice, European Journal of Operational Research: 273(3), 801-816. https://www.sciencedirect.com/science/article/abs/pii/S0377221718303412 Eliaspour, B., Eliaspour, D. and Hejazi, A., 2011. The level of development of the health and medical sector in the cities of North Khorasan province using the numerical taxonomy method in 2006, the name of the publication is??? North Khorasan University of Medical Sciences, 3(7), 23-28. https://journal.nkums.ac.ir/article-1-234-fa.html. (In Persian) Emami, R. and Pirzadeh, A., 2020. Investigating the quality of health care services from the perspective of service recipients in comprehensive health service centers in Kohdasht County, Health System Research, 16 (1), 37-29. https://hsr.mui.ac.ir/article-1-29-fa.html. (In Persian) Esmailpour, N. and Shakibamanesh, M., 2019. Analysis of spatial inequality in the enjoyment of urban service uses; Case study: Yazd city, Spatial Planning, 9 (2), 71-88. https://sppl.ui.ac.ir/article_23752.html. (In Persian) Falahat, K., Baradaran Eftekhari, M., Ebadi Ghar, A. and Akhundzadeh, Sh., 2021. Evaluation and research ranking of research centers on social factors affecting health in Iran – a step towards achieving justice in health, Scientific Journal of Kurdistan University of Medical Sciences, 26(2), 126-137. https://sjku.muk.ac.ir/article-1-5268-fa.html. (In Persian) Fallahi, A. and Kafashi, M., 2018. Investigating the effect of social development on social health in Tehran metropolis, Iranian Journal of Social Development Studies, 10(2), 61-72. https://jisds.srbiau.ac.ir/article_12365.html. (In Persian) Hassanpour, M., Ghorbani-zadeh, S., Asadi-Piri, Z., Mohammadi, R., Nouraei Motlagh, S., 2021. Investigating the status of the distribution trend of dentists in Lorestan Province. Quarterly Journal of Health Care Management, 12 (2), 57-69. https://jhm.srbiau.ac.ir/article_18461.html. (In Persian) Ismail, M., 2020. Regional disparities in the distribution of Sudan’s health resources, Eastern Mediterranean health journal: 26(9), 1105-1114. https://pubmed.ncbi.nlm.nih.gov/23810172/ Jafari, M., Mousavi, S., Anjem Shoa, M., Ezzati Athar, M., Rajabi Vasokkalai, Q. and Sadeghifar, J., 2017. Presenting a combined method for ranking Ilam cities in terms of access to health and medical services, Ilam University of Medical Sciences, 25(2), 155-144. https://sjimu.medilam.ac.ir/browse.php?a_id=2384&slc_lang=fa&sid=1&printcase=1&hbnr=1&hmb=1. (In Persian) Jahangiri, A., Jahangiri, M. and Mosali, A., 2017. Ranking of Iranian provinces in terms of the existence of health and treatment resources and the level of access of individuals to them using multi-criteria decision-making, Health and Treatment Management, 8 (3), 73-84. https://jhm.srbiau.ac.ir/article_11341.html. (In Persian) Karimzadeh, M. and Karimzadeh, B., 2018. Measuring the level of development of the cities of Sistan and Baluchestan province in terms of access to health services, Zanko Journal of Medical Sciences, 19(62), 18-30. https://jzpm.marvdasht.iau.ir/article_3553.html. (In Persian) Kazemi, A., Rezapour, A., Bagheri Faradanbeh, S., Nakhaei, M. and Ghazanfari, S., 2015. The level of development of Iranian provinces with a focus on health sector indicators, Health Management Quarterly, 18(59), 42-29. https://jha.iums.ac.ir/article-1-1598-fa.html. (In Persian) Lee, E., Hamelin, T. and Dauterty, J., 2018. Globalization of health service: sharing of best practices in perianesthesia nursing care, a case study of cross-border institutional collaboration. journal of perianesthesia nursing: 33(2), 209-219. https://pubmed.ncbi.nlm.nih.gov/29580600/ McCarthy, M., Cluzel, E., Dressel, K. and Newton, R., 2013. Food and health research in Europe: Structures, gaps and futures. Food Policy: 39, 64-71. https://doi.org/10.1016/j.foodpol.2012.12.005 Mohammadi, A. and Hashemi Masoumabad, R., 2020. Survey and analysis of the level of access of neighborhoods in Ardabil city to urban services (health centers, etc.). Journal of Health and Wellness, 11(3), 367-383. https://healthjournal.arums.ac.ir/browse.php?a_code=A-10-608-148&sid=1&slc_lang=fa. (In Persian) Mohammadi, S., Mohammadi, C. and Hedayat, A., 2018. Measuring and analyzing inequality in access to health services in the cities of Kermanshah province, Journal of Physical Development Planning, 3(4), 27-44. https://psp.journals.pnu.ac.ir/article_5652.html. (In Persian) Najarzadeh, M., Torabi, Z., Shokriani, M. and Hassani Jalilian, P., 2020. Studying spatial justice in health care indicators in the cities of Golestan province, Scientific Quarterly of Strategic Studies in Public Policy, 10 (36), 281-260. https://sspp.iranjournals.ir/article_243115.html. (In Persian) Pai Yogesh, P. and Chary Satyanarayana, T., 2013. Dimensions of hospital service quality: a critical review, International journal of health care quality assurance. https://pubmed.ncbi.nlm.nih.gov/23795424/ Palacios, A., Espinola, N. and Rojas-Roque, C., 2020. Need and inequality in the use of health care services in a fragmented and decentralized health system: evidence for Argentina. International journal for equity in health: 19(1),1-14. https://d-nb.info/1218346175/34 Parizadi, T. and Mirzazadeh, H., 2018. Regional Development in Iran: The Role of Distributive Justice, Applied Research in Geographical Sciences, 18 (50), 198-179. https://jgs.khu.ac.ir/article-1-2743-fa.html. (In Persian) Rahmatpour, P., Imamgholipour, S., Moghaddamnia, M. and Tavakoli, M., 2017. A look at the distribution of health and medical resources in Guilan Province in 2011 and 2013, Journal of the Faculty of Paramedical Sciences, Tehran University of Medical Sciences (Payavard Salamat), 11 (3) 370-361. https://payavard.tums.ac.ir/article-1-6311-fa.html. (In Persian) Raisi, M. and Raisi, A., 2015. A study on measuring the development of Shiraz city areas, Quarterly Journal of Urban Research and Planning, 6(21), 121-138. https://jupm.marvdasht.iau.ir/article_833.html. (In Persian) Sadeghifar, J., Seydin, S., Anjem Shoa, M., Rajabi Vasokkalai, Q., Mousavi, S. and Armon, B., 2014. Determining the development of cities in Bushehr province in terms of health care indicators using the numerical taxonomy method, Razi Journal of Medical Sciences, 21 (118), 81-91. https://rjms.iums.ac.ir/article-1-3006-fa.html. (In Persian) Safari, K., Abdollahzadeh Taraf, A., Mousavi, M. and Faramarzi Asl, M., 2021. Evaluation of the criterion of spatial justice in the spatial distribution of medical-health services in Iranian-Islamic cities; a case study of Urmia, Quarterly Journal of Geographical Research, 36 (3), 342 – 355. https://georesearch.ir/article-1-1111-fa.html. (In Persian) Salahshouri, M., Ahmadi-Kohanali, R. and Heyrani, A., 2022. Scenario planning of health services in the Makran coastal region using the morphological analysis method, Quarterly Journal of Geographical Studies of Coastal Areas, 3 (1), 61-82. https://hgscaj.guilan.ac.ir/article_5571.html. (In Persian) Salimi, F. and Parsapour, M., 2021. The optimal basis for civil liability from the perspective of economic analysis of law (with a view to commercial law), Private Law Research, 9 (35), 66-42. https://jplr.atu.ac.ir/article_13196.html. (In Persian) Shahraki, M. and Abbasi Hassanabadi, N., 2018. Ranking of cities in Sistan and Baluchestan province based on health and treatment indicators using the TOPSIS method, Payavard Salamat Journal, 12 (6), 433-446. https://payavard.tums.ac.ir/browse.php?a_code=A-10-1356-3&slc_lang=fa&sid=1. (In Persian) Shayan, M., Barki, H., Rezaei, A. and Salmanpour, F., 2019. Investigating the extent of health services in the cities of Isfahan province using the Prometheus technique, Quarterly Journal of Land Geography, 16(61), 75-90. https://sarzamin.srbiau.ac.ir/article_14854.html. (In Persian) Sobhani, N., Akbari, M., Norouzi Sile, N. and Ranjbarzadeh, S., 2019. An analysis of the efficiency and inefficiency of Iranian cities in terms of health services; Case: Khuzestan cities, Journal of Geographical Spatial Planning, 9(32), 50-33. https://gps.gu.ac.ir/article_91048.html. (In Persian) Statistical Center of Iran, 2016. General Population and Housing Census. Statistical Yearbook of Tehran Province 2019. (In Persian) Tehran Province Health and Treatment Deputy, 2021. (In Persian) Vidal, D. G., Pontes, M., Barreira, M. E., Oliveira, G. and Maia, R. L., 2018. Differential mortality and inequalities in health services access in mainland Portugal, Finisterra: 53(109), 53-70. https://bdigital.ufp.pt/handle/10284/7650 Xia, Y., Chen, H., Zuo, C. and Zhang, N., 2022. The impact of traffic on equality of urban healthcare service accessibility: A case study in Wuhan, China, Sustainable Cities and Society: 86, 104130. https://www.sciencedirect.com/science/article/abs/pii/S2210670722004437 Xing, J. and Ng, S. T., 2022. Analyzing spatiotemporal accessibility patterns to tertiary healthcare services by integrating total travel cost into an improved E3SFCA method in Changsha, China, Cities: 122, 103541. https://trid.trb.org/view/1901502
| ||
|
آمار تعداد مشاهده مقاله: 481 تعداد دریافت فایل اصل مقاله: 40 |
||