School of Humanities and Law, Northeastern University, 195 Chuangxin Road, Hunnan District, Shenyang, 110169, Liaoning Province, China.
BMC Health Serv Res. 2023 Nov 23;23(1):1293. doi: 10.1186/s12913-023-10266-4.
As approximately 3/4 of the population lives in county-level divisions in China, the allocation of health resources at the county level will affect the realization of health equity. This study aims to evaluate the disparity in hospital beds at the county level in China, analyze its causes, and discuss measures to optimize the allocation.
Data were drawn from the Chinese County/City Statistical Yearbook (2001-2020). The health resource density index (HRDI) was applied to mediate between the influence of demographic and geographical factors on the allocation of hospital beds. The trends of HRDI allocation were evaluated through the growth incidence curve and the probability density function. The regional disparity in the HRDI was examined through the Lorenz curve, and Dagum Gini coefficient. The contribution of the Gini coefficient and its change were assessed by using the Dagum Gini decomposition method.
From 2000 to 2019, the number of hospital beds per thousand people at the county level in China increased dramatically by 1.49 times. From the aspect of the HRDI, there were large regional disparities at the national level, with a Gini coefficient of 0.367 in 2019 and in the three subregions. In 2019, the Gini coefficient of the HRDI exhibited regional variations, with the highest value observed in the western region, followed by the central region and the eastern region. Decomposition reveals that the contribution of interregional disparity changed from the dominant factor to the least important factor, accounting for 29.79% of the overall disparity and the contribution of trans-variation intensity increased from 29.19% to 39.75%, whereas the intraregional disparity remained stable at approximately 31% and became the second most important factor.
The regional disparity in hospital beds allocation at the county level in China was large and has not improved substantially. Trans-variation intensity was the main reason for the overall disparity and changes, and the intraregional disparity was more important than the interregional disparity for the overall disparity.
由于中国约有 3/4 的人口生活在县级行政区，因此县级卫生资源的分配将影响卫生公平性的实现。本研究旨在评估中国县级医院床位的分配差异，分析其原因，并探讨优化配置的措施。
数据来自《中国县（市）统计年鉴（2001-2020 年）》。采用卫生资源密度指数（HRDI）来调节人口和地理因素对医院床位配置的影响。通过增长发生率曲线和概率密度函数评估 HRDI 配置的趋势。通过 Lorenz 曲线和 Dagum Gini 系数评估 HRDI 的区域差异。采用 Dagum Gini 分解法评估 Gini 系数的贡献及其变化。
从 2000 年到 2019 年，中国县级每千人病床数增长了 1.49 倍。从 HRDI 来看，全国层面存在较大的区域差异，2019 年基尼系数为 0.367，三个分区域也存在较大的区域差异。2019 年，HRDI 的基尼系数呈现区域变化，西部地区最高，其次是中部地区和东部地区。分解结果表明，区域间差异的贡献由主导因素变为最不重要的因素，占总差异的 29.79%，跨方差强度的贡献从 29.19%增加到 39.75%，而区内差异保持在 31%左右，成为第二重要因素。
中国县级医院床位配置的区域差异较大，且没有显著改善。跨方差强度是总差异和变化的主要原因，区内差异对总差异比区际差异更为重要。
