Institute of Higher Education, Beihang University, Beijing, China.
Education Section, Aerospace Center Hospital/Peking University Aerospace School of Clinical Medicine, Beijing, China.
Front Public Health. 2022 Jan 18;9:800163. doi: 10.3389/fpubh.2021.800163. eCollection 2021.
The finance of health professional education (HPE) is of immense importance for effective and sustainable health systems, yet relevant empirical research was scarce due to the lack of financial data. The study aimed to bridge the gap by presenting the scenario of finance for health professional institutions (HPIs) of different tiers in China and exploring how the stratification of institutions affected their funding disparities. The study employed data collected from the Ministry of Education in China, and selected the HPIs mainly based on the World Directory of Medical Schools. The funding levels and disparities of China's HPIs during the period (1998-2017) were analyzed with descriptive statistics, and the indicators of funding per institution and funding per student were both considered. The average funding in HPIs was presented by tiers, and the Gini coefficient and Theil index were employed to describe the differences in financing among HPIs over the span. The study found that the number of HPIs has kept growing over the past two decades, with both the funding per institution and the funding per student increasing steadily. Specifically, the average funding per institution of the three tiers increased by 31.5 times, 13.4 times, and 10.5 times separately, with the first-tier universities having an absolute advantage compared to lower tiers. As for the financing disparities among HPIs, the Gini coefficient of the funding per institution maintained to be over 0.5, with the third-tier institutions scoring the highest, while the Gini coefficient of the funding per student all ranged approximately from 0.2 to 0.3. Through the decomposition of the inequalities measured by the Theil index, the share of the between-tier difference in per-institution funding grew from 29.7 in 1998 to 77.9% in 2017. The funding disparities between tiers of HPIs in China gradually became more accentuated, with the top-tier institutions taking up the largest share. Although the stratified development in HPE has posed a challenge to the unified quality assurance of medical personnel training, it may also be regarded as an effective pathway for developing countries like China to achieve stable development in health professional education.
卫生专业教育（HPE）的财政状况对于有效的和可持续的卫生系统至关重要，但由于缺乏财务数据，相关的实证研究很少。本研究旨在通过展示中国不同层次卫生专业机构（HPIs）的财务状况，并探讨机构分层如何影响其资金差距，来填补这一空白。该研究采用了中国教育部收集的数据，并主要根据世界医学院校名录选择了 HPIs。使用描述性统计方法分析了中国 HPIs 在这一时期（1998-2017 年）的资金水平和差距，同时考虑了每个机构的资金指标和每个学生的资金指标。按层次呈现 HPIs 的平均资金，并使用基尼系数和泰尔指数来描述这 20 年来 HPIs 之间的融资差异。研究发现，过去二十年中，HPIs 的数量一直在增长，每个机构的资金和每个学生的资金都在稳步增长。具体来说，三个层次的每个机构的平均资金分别增长了 31.5 倍、13.4 倍和 10.5 倍，第一层次的大学与较低层次的大学相比具有绝对优势。至于 HPIs 之间的融资差距，机构资金基尼系数一直保持在 0.5 以上，第三层次的机构得分最高，而学生资金基尼系数均约在 0.2 到 0.3 之间。通过泰尔指数衡量的不平等分解，机构资金分配的层次间差异份额从 1998 年的 29.7%增长到 2017 年的 77.9%。中国 HPIs 之间的资金差距逐渐加大，顶级机构占据了最大份额。虽然 HPE 的分层发展对医学人才培训的统一质量保证提出了挑战，但它也可能被视为中国等发展中国家实现卫生专业教育稳定发展的有效途径。
