China Center for Health Development Studies, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, China.
School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, China.
Health Policy Plan. 2018 Sep 1;33(7):821-827. doi: 10.1093/heapol/czy061.
A strong health workforce is widely recognized as a prerequisite for health care and a crucial determinant of health system performance. The number of health professionals in China increased following the 2009 health system reform, which, in part, aimed to address the shortage and unequal distribution of health professionals. We examined whether the distribution of health professionals was more equitable following the reform and whether the reform had targeted impacts in terms of the quantity of health professionals. We interacted economic (poor and non-poor counties) and geographic (eastern, central and western regions) dimensions to more precisely target vulnerable areas, focussing on the quantity and distribution of health professionals in rural China. We used a county-level longitudinal dataset from the National Health and Family Planning Commission consisting of 1978 counties in all 31 provinces in rural China, with measurements taken every other year from 2008 to 2014. The distribution of health professionals was summarized using descriptive and interaction analyses. We found a constant improvement in the number of health professionals per 1000 population co-existing with a worsening of the distribution across rural China following the health system reform. Most of the non-poor counties improved faster compared with poor counties across all geographic regions, especially in the western and eastern regions. The growth of the number of health professionals per 1000 population was greatest and fastest in western-non-poor counties and least and slowest in eastern-poor counties. As an example of the 'Central Region Downfall' phenomenon, the central counties (both poor and non-poor) performed poorly in terms of the quantity and distribution of health professionals. Based on an analysis of multiple dimensions, targeted and differential measures should be taken to reduce inequalities, and the central region should not be ignored in efforts to improve the distribution of health professionals in rural China.
一个强大的卫生人力队伍被广泛认为是医疗保健的前提条件，也是卫生系统绩效的关键决定因素。中国的卫生专业人员数量在 2009 年医改后有所增加，部分目的是解决卫生专业人员短缺和分布不均的问题。我们研究了医改后卫生专业人员的分布是否更加公平，以及医改在卫生专业人员数量方面是否有针对性的影响。我们将经济（贫困和非贫困县）和地理（东部、中部和西部地区）维度进行了交互，以更精确地瞄准脆弱地区，重点关注中国农村地区卫生专业人员的数量和分布。我们使用了国家卫生和计划生育委员会的县级纵向数据集，该数据集包含了中国所有 31 个省份的 1978 个县，从 2008 年到 2014 年每两年进行一次测量。使用描述性和交互分析总结了卫生专业人员的分布情况。我们发现，随着医改的推进，每千人口卫生专业人员数量不断增加，但农村地区的分布情况却在恶化。与贫困县相比，所有地理区域的非贫困县都在加快改善，尤其是在西部地区和东部地区。每千人口卫生专业人员数量的增长在西部非贫困县最大最快，而在东部贫困县最小最慢。作为“中部地区衰落”现象的一个例子，中部地区（贫困县和非贫困县）在卫生专业人员的数量和分布方面表现不佳。基于对多个维度的分析，应该采取有针对性和差异化的措施来减少不平等，在努力改善中国农村地区卫生专业人员分布方面，不应忽视中部地区。
