School of Medicine, Hangzhou Normal University, Hangzhou, 310036, Zhejiang, China.
The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
Int J Equity Health. 2020 Feb 26;19(1):28. doi: 10.1186/s12939-020-1139-3.
Equity is one of the major goals of China's new medical reforms launched in 2009. This study aimed to analyze the disequilibrium in primary health care (PHC) workforce among various economic zones in China and to compare the fairness between urban and rural areas since the implementation of the new medical reforms.
According to China's 11th Five-Year Plan, China is divided into eight economic regions. The data of this study were obtained from China Statistical Yearbook 2009-2016. The Atkinson index was used to depict the trend of PHC workforce fairness; the Gini coefficient was used to compare the fairness of workforce distribution between urban and rural areas; the health resource agglomeration degree was used to analyze the distributional equity of the workforce in the eight regions; and the Theil Index was used to compare the fairness of urban and rural workforce distribution across eight regions.
The Atkinson index indicated that the equity of the entire PHC workforce allocation had generally improved during the new medical reforms; the Gini coefficient indicated that the fairness of the entire workforce allocation had improved in cities, but only the nurse allocation became fairer in rural areas. The agglomeration degree and the Theil index indicated that the fairness gaps across the eight regions were still large. These analyses differed from previous studies where China was divided into western, central and eastern regions. In what was previously defined as eastern region, the northeast was under-resourced, while the eastern coastal areas were observing a resource surplus. In western region, we found that the fairness in the northwest was significantly worse than southwest.
In China, the distribution of healthcare workforce has been improved with continuous effort. The gaps in the distribution of PHC workforce across different economic regions and between urban and rural areas are still large, with different regions facing different problems. The government should consider the population and geographical factors in allocation of PHC workforce, especially nurses.
公平是中国 2009 年启动的新医改的主要目标之一。本研究旨在分析中国不同经济区域基层卫生人力配置的不平衡，并比较新医改实施前后城乡之间的公平性。
根据中国“十一五”规划，中国分为八大经济区域。本研究的数据来自中国统计年鉴 2009-2016。采用阿特金森指数描述基层卫生人力公平性的变化趋势；基尼系数比较城乡劳动力分布的公平性；卫生资源集聚度分析 8 个区域劳动力分布的分配公平性；泰尔指数比较 8 个区域城乡劳动力分布的公平性。
阿特金森指数表明，新医改以来，整个基层卫生人力配置的公平性总体上有所提高；基尼系数表明，城市整体劳动力配置的公平性有所提高，但农村地区只有护士的配置变得更加公平。集聚度和泰尔指数表明，八个地区之间的公平差距仍然很大。这些分析与之前将中国分为西部、中部和东部地区的研究不同。在之前被定义为东部地区的地区，东北地区资源不足，而东部沿海地区则出现资源过剩。在西部地区，我们发现西北地区的公平性明显不如西南地区。
中国基层卫生人力的分布在不断努力下得到了改善。不同经济区域和城乡之间基层卫生人力配置的差距仍然很大，不同地区面临着不同的问题。政府在分配基层卫生人力时，应考虑人口和地理因素，特别是护士。
