Dong Enhong, Wang Tingting, Xu Ting, Chen Xueting, Zhou Qianqian, Gao Weimin, Liu Yuping
School of Nursing and Health Management, Shanghai University of Medicine & Health Science, Shanghai, China.
Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, Shanghai, China.
Front Public Health. 2025 Jul 18;13:1586585. doi: 10.3389/fpubh.2025.1586585. eCollection 2025.
As economic growth drives higher demand for health services, equitable health resource allocation becomes crucial to meet diverse healthcare needs. Since China's reform and opening-up, increased government healthcare investment has not fully resolved regional disparities. Existing studies, often relying on methods other than the concentration index, fail to comprehensively analyze the link between resource inequities and economic factors. This study uses the concentration index and its decomposition to assess regional disparities and identify determinants of inequity, offering practical recommendations for optimizing resource distribution in China and similar developing nations.
This study analyzed China's healthcare resource allocation (institutions, beds, and workforce) from 2009 to 2021 using the concentration index to measure equity across socio-economic regions and its decomposition method to identify contributing factors to inequality.
From 2009 to 2021, the numbers of institutions per 1,000 people (IPK), beds per 1,000 people (BPK), doctors per 1,000 people (DPK), technicians per 1,000 people (TPK), and nurses per 1,000 people(NPK) in China increased. The concentration index (CI) for IPK remained negative, while BPK's CI turned negative after 2013. CIs for DPK, TPK, and NPK stayed positive. The CI for IPK's absolute value rose, while others decreased. Factors like population size (PS), population density(PD), geographical Location(GL), maternal mortality rate(MMR), rate of born-baby weighting less than 2.5 kg (RBWL25), and perinatal mortality rate (PMR) influenced unequal healthcare resource distribution, with PS and RBWL25 favoring developed areas, and PD, GL, and MMR favoring less developed regions. Additionally, urbanization level (UL), Out-of-Pocket (OPP), per capita health expenditures(PCHE), per capita gross domestic product(PCGDP), disposable income of urban residents(DIUR), government health expenditures (GHE), and number of insured(NI) positively impacted resource allocation to developed provinces, with varying effects.
This study analyzes 2009-2021 panel data, revealing growth trends and regional disparities in China's healthcare resource equity, focusing on institutions, beds, and workforce. Need variables (PS, PD, and RBWL25) reduced bed/doctor disparities, while MMR/PMR worsened maternal/nurse inequities. Non-need economic factors concentrated resources in affluent areas despite redistribution efforts. The findings highlight ongoing challenges in equitable distribution and offer crucial policy insights for China and other developing nations.
随着经济增长推动对卫生服务的需求增加，公平的卫生资源分配对于满足多样化的医疗保健需求至关重要。自中国改革开放以来，政府增加的医疗保健投资尚未完全解决地区差异问题。现有研究往往依赖于集中度指数以外的方法，未能全面分析资源不平等与经济因素之间的联系。本研究使用集中度指数及其分解方法来评估地区差异并确定不平等的决定因素，为优化中国及其他类似发展中国家的资源分配提供切实可行的建议。
本研究分析了2009年至2021年中国的医疗保健资源分配（机构、床位和劳动力），使用集中度指数衡量各社会经济区域的公平性，并采用其分解方法确定不平等的影响因素。
2009年至2021年，中国每千人机构数（IPK）、每千人床位数（BPK）、每千人医生数（DPK）、每千人技术人员数（TPK）和每千人护士数（NPK）均有所增加。IPK的集中度指数（CI）保持为负，而BPK的CI在2013年后变为负数。DPK、TPK和NPK的CI保持为正。IPK的CI绝对值上升，而其他指数下降。人口规模（PS）、人口密度（PD）、地理位置（GL）、孕产妇死亡率（MMR）、低体重儿出生率（RBWL25）和围产儿死亡率（PMR）等因素影响了医疗保健资源分配的不平等，其中PS和RBWL25有利于发达地区，而PD、GL和MMR有利于欠发达地区。此外，城市化水平（UL）、自付费用（OPP）、人均卫生支出（PCHE）、人均国内生产总值（PCGDP）、城镇居民可支配收入（DIUR）、政府卫生支出（GHE）和参保人数（NI）对发达省份的资源分配产生了积极影响，但其影响程度各不相同。
本研究分析了2009 - 2021年的面板数据，揭示了中国医疗保健资源公平性的增长趋势和地区差异，重点关注机构、床位和劳动力。需求变量（PS、PD和RBWL25）减少了床位/医生的差异，而MMR/PMR加剧了孕产妇/护士的不平等。尽管进行了再分配努力，但非需求经济因素仍将资源集中在富裕地区。研究结果凸显了公平分配方面持续存在的挑战，并为中国和其他发展中国家提供了关键的政策见解。
