The disequilibrium in the distribution of the primary health workforce among eight economic regions and between rural and urban areas in China
The disequilibrium in the distribution of the primary health workforce among eight economic regions and between rural and urban areas in China
复制标题
中国八个经济区域和城乡基层卫生人力分布不均衡
DOI：
10.1186/s12939-020-1139-3
复制
发表时间：
2020-02-26
影响因子：
4.8
通讯作者：
Meng, Jiayu
中科院分区：
文献类型：
--
作者：
Wang, Yueyue;Li, Yuyang;Meng, Jiayu
背景公平是中国2009年启动的新医改的主要目标之一。本研究旨在分析新医改以来我国各经济区初级卫生保健人力资源配置的不均衡性，并比较城乡之间的公平性。方法根据中国“十一五”规划，将中国划分为八大经济区域。本研究的数据来源于《中国统计年鉴2009-2016》。采用Atkinson指数描述卫生人力公平性的变化趋势;采用基尼系数比较城乡卫生人力分布的公平性;采用卫生资源集聚度分析8个地区卫生人力分布的公平性;采用泰尔指数比较8个地区城乡卫生人力分布的公平性。结果Atkinson指数显示新医改期间基层卫生人力整体配置公平性总体上有所改善;基尼系数显示城市基层卫生人力整体配置公平性有所改善，但农村地区只有护士配置公平性有所改善。集聚度和泰尔指数表明，八个地区之间的公平差距仍然很大。这些分析不同于以往的研究，中国分为西部，中部和东部地区。在以前被定义为东部地区的地区，东北部资源不足，而东部沿海地区则出现资源过剩。在西部地区，西北地区的公平性显著差于西南地区。结论经过不断努力，我国卫生人力资源配置状况得到改善。不同经济区域和城市与农村地区之间初级保健工作人员的分布差距仍然很大，不同区域面临不同的问题。政府在配置初级卫生保健人员时应考虑人口和地理因素，特别是护士。
Background Equity is one of the major goals of China's new medical reforms launched in 2009. This study aimed to analyze the disequilibrium in primary health care (PHC) workforce among various economic zones in China and to compare the fairness between urban and rural areas since the implementation of the new medical reforms. Method According to China's 11th Five-Year Plan, China is divided into eight economic regions. The data of this study were obtained from China Statistical Yearbook 2009-2016. The Atkinson index was used to depict the trend of PHC workforce fairness; the Gini coefficient was used to compare the fairness of workforce distribution between urban and rural areas; the health resource agglomeration degree was used to analyze the distributional equity of the workforce in the eight regions; and the Theil Index was used to compare the fairness of urban and rural workforce distribution across eight regions. Result The Atkinson index indicated that the equity of the entire PHC workforce allocation had generally improved during the new medical reforms; the Gini coefficient indicated that the fairness of the entire workforce allocation had improved in cities, but only the nurse allocation became fairer in rural areas. The agglomeration degree and the Theil index indicated that the fairness gaps across the eight regions were still large. These analyses differed from previous studies where China was divided into western, central and eastern regions. In what was previously defined as eastern region, the northeast was under-resourced, while the eastern coastal areas were observing a resource surplus. In western region, we found that the fairness in the northwest was significantly worse than southwest. Conclusion In China, the distribution of healthcare workforce has been improved with continuous effort. The gaps in the distribution of PHC workforce across different economic regions and between urban and rural areas are still large, with different regions facing different problems. The government should consider the population and geographical factors in allocation of PHC workforce, especially nurses.