School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China.
Department of Public Policy, City University of Hong Kong, Hong Kong SAR, PR China.
Int J Health Plann Manage. 2019 Jan;34(1):e487-e508. doi: 10.1002/hpm.2664. Epub 2018 Sep 20.
China has long been negatively affected by a shortage and maldistribution of health workers. This study aimed to examine the national and regional trends in the demographic and geographic distribution inequality of health care professionals in China from 2002 to 2016. Based on data from the China Health and Family Planning Statistical and China Statistical Yearbooks, we calculated the Gini coefficient and the Theil T and Theil L indices based on the number of health care professionals per capita and per geographic area to measure the inequalities in their demographic and geographic distribution, respectively. The contributions by intra-regional and inter-regional differences on total inequality were explored within and among East, Central, and West China via Theil index decomposition. We found that the national demographic distribution of health care professionals maintained in an absolute equality level, and the inequality indices decreased gradually, whereas the corresponding geographic inequalities were severe and presented a worsening trend. Compared with nurses, physicians not only maintained higher densities but also maintained a more equal distribution. Intra-regional disparities within the east, central, and western regions were the main cause for overall demographic inequality, whereas both intra-regional and inter-regional disparities significantly contributed to overall geographic inequality. To conclude, the distribution equality of health care professionals by population was satisfactory, whereas the corresponding distribution inequality by area was severe. Different types of distribution inequality of health care professionals existed regionally and nationally despite their increasing quantities and densities. Factors beyond population size should be considered when the government introduces health workforce allocation policies.
中国长期以来一直受到卫生工作者短缺和分布不均的负面影响。本研究旨在探讨 2002 年至 2016 年期间中国卫生保健专业人员的人口和地理分布不均的全国和区域趋势。本研究基于中国卫生和计划生育统计数据以及中国统计年鉴中的数据，根据人均和每地理区域的卫生保健专业人员数量，分别计算基尼系数、泰尔 T 指数和泰尔 L 指数，以衡量其人口和地理分布的不平等程度。通过泰尔指数分解，探讨了区域内和区域间差异对总不平等的贡献。结果发现，全国卫生保健专业人员的人口分布保持在绝对平等水平，不平等指数逐渐下降，而相应的地理不平等则较为严重且呈恶化趋势。与护士相比，医生不仅保持了更高的密度，而且分布也更加均衡。东部、中部和西部地区内部的区域内差异是造成整体人口不平等的主要原因，而区域内和区域间差异均显著导致了整体地理不平等。总之，卫生保健专业人员的人口分布平等程度令人满意，而相应的面积分布不平等程度则较为严重。尽管卫生保健专业人员的数量和密度不断增加，但在全国和区域层面仍存在不同类型的分布不平等。政府在制定卫生人力配置政策时，应考虑人口规模以外的因素。
