Health workforce equity in urban community health service of China.
Health workforce equity in urban community health service of China.
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DOI：
10.1371/journal.pone.0115988
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Guo A
中科院分区：
文献类型：
--
作者：
Chen R;Zhao Y;Du J;Wu T;Huang Y;Guo A
揭示我国城市社区卫生服务机构卫生人力配置的公平性，为进一步发展我国社区卫生服务提供依据。2011年9月至12月在中国进行了一项基于社区的横断面研究。本研究采用分层多阶段整群抽样的方法，从全国10个省、自治区、直辖市抽取190个社区卫生服务中心。收集各社区卫生服务中心的人力资源概况和基本特征。采用洛伦茨曲线和基尼系数测算社区卫生服务中心卫生人力资源按人口规模和地理区域分布的不平等程度。采用配对样本Wilcoxon秩和检验分析不同健康指标间的公平性差异。平均每万人有7.37名卫生工作者，其中医生3.25名，护士2.32名。各样本的各项指标均存在显著差异，其中北京、山东和浙江的排名最高。每10 000人中卫生工作者、医生和护士的基尼系数分别为0.39、0.44和0.48。每万人口医生数的公平性（G = 0.39）优于每平方公里医生数的公平性（G = 0.44）（P = 0.005）。 在6,573名卫生工作者中，本科及以上学历1,755人（26.7%），大专学历2,722人（41.4%），高中学历215人（3.3%）。大学及以上学历人员分布的不公平性显著（G = 0.52），高于每万人口卫生工作人员分布的不公平性（P<0.001）。 卫生人力的不公平性在这项研究中发现，特别是在质量和地理分布。这些研究结果表明，需要更多的创新政策，以改善中国城市社区卫生服务中心的健康公平。
To reveal the equity of health workforce distribution in urban community health service (CHS), and to provide evidence for further development of community health service in China. A community-based, cross-sectional study was conducted in China from September to December 2011. In the study, 190 CHS centers were selected from 10 provinces of China via stratified multistage cluster sampling. Human resources profiles and basic characteristics of each CHS centers were collected. Lorenz curves and Gini Coefficient were used to measure the inequality in the distribution of health workforce in community health service centers by population size and geographical area. Wilcoxon rank test for paired samples was used to analyze the differences in equity between different health indicators. On average, there were 7.37 health workers, including 3.25 doctors and 2.32 nurses per 10,000 population ratio. Significant differences were found in all indicators across the samples, while Beijing, Shandong and Zhejiang ranked the highest among these provinces. The Gini coefficients for health workers, doctors and nurses per 10,000 population ratio were 0.39, 0.44, and 0.48, respectively. The equity of doctors per 10,000 population ratio (G = 0.39) was better than that of doctors per square kilometer (G = 0.44) (P = 0.005). Among the total 6,573 health workers, 1,755(26.7%) had undergraduate degree or above, 2,722(41.4%)had junior college degree and 215(3.3%) had high school education. Significant inequity was found in the distribution of workers with undergraduate degree or above (G = 0.52), which was worse than that of health works per 10000 population (P<0.001). Health workforce inequity was found in this study, especially in quality and geographic distribution. These findings suggest a need for more innovative policies to improve health equity in Chinese urban CHS centers.
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