Witthayapipopsakul Woranan, Cetthakrikul Nisachol, Suphanchaimat Rapeepong, Noree Thinakorn, Sawaengdee Krisada
Health Financing Node, International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand,
Health Promotion Policy Research Centre, International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand.
Risk Manag Healthc Policy. 2019 Feb 5;12:13-22. doi: 10.2147/RMHP.S181174. eCollection 2019.
Geographical maldistribution has been a critical concern of health workforce planning in Thailand for years. This study aimed to assess the equity of health workforce distribution in public hospitals affiliated to the Office of Permanent Secretary (OPS) of the Ministry of Public Health (MOPH) through the application of "concentration index" (CI).
A cross sectional quantitative design was employed. The dataset comprised 1) health workforce data from the OPS, MOPH in 2016, 2) regional and provincial-level economic data from the National Economic and Social Development Board in 2015, and 3) population data from the Ministry of Interior in 2015. Descriptive statistics, Spearman's rank correlation, and CI analysis were performed.
Thailand had 2.04 health professionals working in public facilities per 1,000 population. Spearman's correlation found positive relationship in all health professionals. Yet, statistical significance was not found in most health professionals but doctors (<0.001). Positive correlation was observed in all health cadres at regional and provincial hospitals ( =0.348, =0.002). In the CI analysis, the distribution of health professionals across provincial income was relatively equitable in all cadres. Significant CIs were found in doctor density (CI =0.055, =0.001), all professionals density at district hospitals (CI =-0.049, =0.012), and all professionals density at provincial and regional hospitals (CI =0.078, =0.003).
The positive CIs implied that the distribution of all health professionals, especially doctors, at provincial and regional hospitals slightly favored the richer provinces. In contrast, the distribution at district hospitals was slightly more concentrated in less well-off provinces. From a macro-view, the distribution of all health professionals in Thailand was relatively equitable across provincial economic status. This might be due to the extensive health infrastructure development and rural retention policies over the past four decades.
多年来，地理分布不均一直是泰国卫生人力规划的一个关键问题。本研究旨在通过应用“集中指数”（CI）评估公共卫生部常任秘书办公室（OPS）下属公立医院卫生人力分布的公平性。
采用横断面定量设计。数据集包括：1）2016年公共卫生部常任秘书办公室的卫生人力数据；2）2015年国家经济和社会发展委员会的区域和省级经济数据；3）2015年内政部的人口数据。进行了描述性统计、Spearman等级相关性分析和集中指数分析。
泰国每千人口中有2.04名卫生专业人员在公共机构工作。Spearman相关性分析发现，所有卫生专业人员之间均呈正相关。然而，大多数卫生专业人员（医生除外）未发现统计学意义（<0.001）。在区域和省级医院的所有卫生干部中均观察到正相关（r = 0.348，p = 0.002）。在集中指数分析中，所有干部的卫生专业人员在省级收入水平上的分布相对公平。在医生密度方面发现显著的集中指数（CI = 0.055，p = 0.001），在区级医院所有专业人员密度方面（CI = -0.049，p = 0.012），以及在省级和区域医院所有专业人员密度方面（CI = 0.078，p = 0.003）。
正的集中指数表明，省级和区域医院所有卫生专业人员，尤其是医生的分布略偏向较富裕省份。相比之下，区级医院的分布在较贫困省份更为集中。从宏观角度看，泰国所有卫生专业人员在省级经济状况方面的分布相对公平。这可能归因于过去四十年来广泛的卫生基础设施发展和农村留用政策。
