Equity and efficiency of primary health care resource allocation in mainland China

Abstract

BackgroundChina had proposed the unification of equity and efficiency since the launch of the new round of health system reform in 2009. And the central government gave priority to the development of primary health care (PHC) whilst ensuring its availability and improving its efficiency. This study aimed to evaluate the changes of equity and efficiency in PHC resource allocation (PHCRA) and explored ways to improve the current situation.MethodsThe data of this study came from the China Health Statistical Yearbook (2013–2017) and China Statistical Yearbook (2017). Three and five indicators were used to measure equity and efficiency, respectively. The Lorenz curve, Gini coefficient (G), Theil index (T) and health resource density index (HRDI) were used to assess equity in demographic and geographical dimensions. Data envelopment analysis (DEA) and the Malmquist productivity index (MPI) were chosen to measure the efficiency and productivity of PHCRA.ResultsFrom 2012 to 2016, the total amount of PHCR had increased year by year. The Gs by population size were below 0.2 and that by geographical area were between 0.6 and 0.7. T had the same trend with G, and intra-regional contribution rates were higher than inter-regional contribution rates, which were all beyond 60%. From 2012 to 2016, the numbers of provinces that achieved an effective DEA were 4, 3, 4, 5 and 5, respectively. The mean of the total factor productivity index was 0.994.ConclusionThe equity of PHCRA in terms of population size is superior in the geographical area. Intra-regional differences are the main source of inequality. The eastern region has the highest density of PHCR, whereas the western region has the lowest. In addition, PHC institutions in more than 80% of the provinces are inefficient, and the productivity of the institutions decline by 0.6% from 2012 to 2016 because of technological retrogression.

Equity and efficiency of maternal and child health resources allocation in Hunan Province, China

“…The same result has been found in many previous studies [7,10,21]. One possible explanation for this finding is that government take the number of health resources per thousand persons, instead of per 10,000 km 2 , as the priority for health resources allocation in China [9,12] . It may have also contributed to the geographic disparities in the accessibility of healthcare services [26], which is incompatible with the goal of "Universal Health Coverage" advocated by WHO that recommends every people could get access to affordable and quality healthcare services [27].…”

“…It is derived from the Lorenz curve, indicating the ratio of the area between Lorenz Curve and the 45°line to the whole area below the 45°line. The formula to calculate the Gini coefficient is presented as follows [9]:…”

“…By measuring the distance from the inputs and outputs of inefficient DMUs to their efficient peers, we could calculate the over-supplied inputs and expected outputs for the inefficient DMUs, which can provide the quantitative basis for improving the efficiency of MCH allocation of each DMU. Thus, we preferred to select the BCC model in this study to evaluate the efficiency of MCH resources allocation [9,23].…”

“…A total of 8 indicators were selected in this study to evaluate the equity in MCH resources allocation. Human resources and capital are regarded as the important input/output variables in the delivery of health services [9]. The number of doctors, nurses, midwives, and administrative staff members represents human resources, and the MCHHs, beds, operating areas, medical equipment with a value of ≥ CNY 10,000 (above $1420) represents the capital.…”

“…The question about how health resources should be allocated, so that they are distributed in both the most equitable and most efficient way should be an important concern in MCH system. Studies to date, however, have mainly focused on the equity and efficiency of health resources allocation in primary health care [9,10], overall health care [11,12], or specific health-care institutions such as public hospitals [13] and county hospitals [6]. Although some studies focus on the MCH resources allocation in China, most studies was conducted in lower-or higher-income regions, with little information available in the middle-income regions [14][15][16][17].…”