Zhou W P, Yang S H, Mu N, Jian W Y
Department of Health Policy and Management, Peking University School of Public Health, Beijing 100191, China.
Peking University School of Public Health, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2022 Jun 18;54(3):477-482. doi: 10.19723/j.issn.1671-167X.2022.03.012.
To analyze the long-term trends of the changes in the equity of China's health workforce allocation to provide a reference for the more balanced and orderly development of China's health system.
The Gini coefficient was used to evaluate the degree of equity in the allocation of health workforce between regions, and the Gini coefficients for the allocation of doctors and nurses based on population and regional gross domestic product (GDP) distribution were calculated respectively.
In 2019, the number of licensed (assistant) physicians per 1 000 population in China was 2.77, and the number of registered nurses per 1 000 population was 3.18. The Gini coefficient for the distribution of licensed (assistant) physicians by population was 0.141 in 2002, decreasing to 0.081 by 2014 and then remained stable. The Gini coefficient for the distribution of registered nurses by population was 0.164 in 2002 and decreased to 0.066 in 2018. The Gini coefficient for the distribution of licensed (assistant) physicians by GDP was 0.236 in 2002, decreased to 0.169 in 2013, then increased to 0.183 and remained stable. The Gini coefficient for the distribution of registered nurses by GDP was 0.206 in 2002, decreased to 0.150 in 2013, and then increased each year to 0.180 in 2019. The equity of the allocation of registered nurses by population was worse than the equity of the allocation of licensed (assistant) physicians in 2002, and in 2016, for the first time, exceeded that of licensed (assistant) physicians.
Equity in the allocation of health workforce across China has improved, but the improvement in equity between regions has hit a bottleneck, with health workforce allocation in the western regions still relatively scarce. Although nursing workforce allocation equity caught up with licensed (assistant) physicians, the number of licensed (assistant) physicians is close to that of developed western countries, while there is a large gap in registered nurses. It is recommended that the relevant authorities make good long-term planning for health workforce, further increase the policy for the introduction of health workforce in the western region, and increase the supply of healthcare services in the western region with the help of digital transformation of healthcare and internet healthcare. At the same time, they should further increase investment in resources for higher nursing education and actively plan to cope with the ageing population.
分析中国卫生人力配置公平性的长期变化趋势，为中国卫生系统更均衡有序发展提供参考。
采用基尼系数评估地区间卫生人力配置的公平程度，分别计算基于人口和地区国内生产总值（GDP）分布的医生和护士配置基尼系数。
2019年，中国每千人口执业（助理）医师数为2.77人，每千人口注册护士数为3.18人。按人口分布的执业（助理）医师基尼系数2002年为0.141，到2014年降至0.081，之后保持稳定。按人口分布的注册护士基尼系数2002年为0.164，2018年降至0.066。按GDP分布的执业（助理）医师基尼系数2002年为0.236，2013年降至0.169，之后升至0.183并保持稳定。按GDP分布的注册护士基尼系数2002年为0.206，2013年降至0.150，之后逐年上升至2019年的0.180。2002年按人口分布的注册护士配置公平性低于执业（助理）医师，2016年首次超过执业（助理）医师。
中国卫生人力配置公平性有所改善，但地区间公平性提升遇瓶颈，西部地区卫生人力配置仍相对匮乏。虽然护理人力配置公平性赶上了执业（助理）医师，但执业（助理）医师数量已接近西方发达国家，而注册护士数量差距较大。建议相关部门做好卫生人力长期规划，进一步加大西部地区卫生人力引进政策力度，借助医疗数字化转型和互联网医疗增加西部地区医疗服务供给。同时，应进一步加大高等护理教育资源投入，积极应对人口老龄化。
