The disequilibrium in the distribution of the primary health workforce among eight economic regions and between rural and urban areas in China

Wang, Yueyue; Yu-yang, LI; Qin, Shangren; Kong, Yuanfeng; Yu, Xiaogang; Guo, Kang; Meng, Jiayu

doi:10.1186/s12939-020-1139-3

Cited by 59 publications

(45 citation statements)

References 13 publications

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“…The distribution of health care resources in Jiangsu Province is generally fair: the fairness distribution according to the population is higher than that according to the geographical area, and the distribution of primary health resources is better than that of financial resources. This finding is consistent with the results of other studies on the equity of health resource allocation in China [24,25]. There are two main reasons for this result: on the one hand, the policies issued by the government aim mainly to meet the medical needs of the population, not the needs of the regional layout [26]; on the other hand, there is a gap in the economic development of Jiangsu Province, which has a certain impact on the supply of medical resources [16].…”

Section: Discussionsupporting

confidence: 93%

Equity and efficiency of health care resource allocation in Jiangsu Province, China

Li¹,

Wu²,

Feng-chang³

et al. 2020

Int J Equity Health

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Background Jiangsu was one of the first four pilot provinces to engage in comprehensive health care reform in China, which has been on-going for the past 5 years. This study aims to evaluate the equity, efficiency and productivity of health care resource allocation in Jiangsu Province using the most recent data, analyse the causes of deficiencies, and discuss measures to solve these problems. Methods Data were extracted from the Jiangsu Health/Family Planning Statistical Yearbook (2015–2019) and Jiangsu Statistical Yearbook (2015–2019). The Gini coefficient (G), Theil index (T) and health resource density index (HRDI) were chosen to study the fairness of health resource allocation in Jiangsu Province. Data envelopment analysis (DEA) and the Malmquist productivity index (MPI) were used to analyse the efficiency and productivity of this allocation. Results From 2014 to 2018, the total amount of health resources in Jiangsu Province increased. The G of primary resource allocation by population remained below 0.15, and that by geographical area was between 0.14 and 0.28; additionally, the G of health financial resources was below 0.26, and that by geographical area was above 0.39. T was consistent with the results for G and Lorenz curves. The HRDI shows that the allocated amounts of health care resources were the highest in southern Jiangsu, except for the number of health institutions. The average value of TE was above 0.93, and the DEA results were invalid for only two cities. From 2014 to 2018, the mean TFPC in Jiangsu was less than 1, and the values exceeded 1 for only five cities. Conclusion The equity of basic medical resources was better than that of financial resources, and the equity of geographical allocation was better than that of population allocation. The overall efficiency of health care resource allocation was high; however, the total factor productivity of the whole province has declined due to technological regression. Jiangsu Province needs to further optimize the allocation and increase the utilization efficiency of health care resources.

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Section: Discussionsupporting

confidence: 93%

Equity and efficiency of health care resource allocation in Jiangsu Province, China

Li¹,

Wu²,

Feng-chang³

et al. 2020

Int J Equity Health

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show abstract

“…Li and Wang carried out regression analysis on different factors that could influence PMHE, and found that fiscal decentralization, household registration system, medical and health system reform, urbanization level, economic development level, population density, and education level have significant influence on input-output efficiency in China [18]. Cheng and Liao, Wang et al believed that fiscal decentralization, population density, together with education level have significant impacts on the efficiency of public health care in China [19,20]. The difference is that the Chen and Liao believed that both of those two had significant positive impacts, while Wang and Tao believed they had negative effects [19,20].…”

Section: Literature Reviewmentioning

confidence: 99%

“…Cheng and Liao, Wang et al believed that fiscal decentralization, population density, together with education level have significant impacts on the efficiency of public health care in China [19,20]. The difference is that the Chen and Liao believed that both of those two had significant positive impacts, while Wang and Tao believed they had negative effects [19,20].…”

Section: Literature Reviewmentioning

confidence: 99%

Is the allocation of medical and health resources effective? Characteristic facts from regional heterogeneity in China

Peng

Zhang

et al. 2020

Int J Equity Health

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Background: Over the last decade, the expenditure on public medical and health has increased greatly in China, however, problems as low efficiency and unfairness still exist. How to accurately describe the effectiveness of existing medical and health resources in combination with regional heterogeneity is of great significance to China's medical and health reform. Methods: Based on provincial panel data for the period of 2005 to 2017, combining expected output and unexpected output, this paper constructs a super-efficiency three-stage SBM-DEA model, to measure and analyze the spatial-temporal heterogeneity characteristics and influencing factors of public medical and health efficiency (PMHE). Results: (1) After the impacts of random error and external environmental factors are removed, the mean value of overall PMHE is 0.9274, failing to reach DEA efficiency, and PMHE shows a fluctuated downward trend. (2) The adjusted PMHE level shows a prominent spatial imbalance at the stage 3. The average efficiency level is ranked by the East > the West > the Central > the Northeast. (3) The increases of GDP per capita and population density are beneficial to the improvement of PMHE, while income level and education level are disadvantageous to PMHE, and last, the urbanization level, an uncertain effect. (4) There is no σ convergence of the PMHE in the East, the Central and the West, that is, the internal differences may gradually expand in the future, while the Northeast shows a significant σ convergence trending of PMHE. (5) The state's allocation of medical and health resources has undergone major changes during "The Twelfth Five-Year Plan". Conclusion: This study innovatively incorporates undesired outputs of health care into the efficiency evaluation framework by constructing the main efficiency evaluation indicators. The results of the robust evaluation conclude that China's existing investment in medical and health resources is generally not effective. Therefore, although China's health care reform has made certain achievement, it is still necessary to expand the investment in health care resources.

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“…The empirical results show that the regional distribution of medical institutions, medical staff, and beds in China is extremely uneven, with the Gini coefficient exceeding 0.7 [7]. In addition, in terms of primary health care and urban and rural medical services, there are significant differences in different regions [8]. Some theorists have suggested that the "economic status of cities accounted for most of the existing inequality" [9].…”

Section: Introductionmentioning

confidence: 99%

Regional Disparity and Patients Mobility: Benefits and Spillover Effects of the Spatial Network Structure of the Health Services in China

Kaibo

Feng

et al. 2021

IJERPH

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Background: The distribution of medical resources in China is seriously imbalanced due to imbalanced economic development in the country; unbalanced distribution of medical resources makes patients try to seek better health services. Against this backdrop, this study aims to analyze the spatial network characteristics and spatial effects of China’s health economy, and then find evidence that affects patient mobility. Methods: Data for this study were drawn from the China Health Statistical Yearbooks and China Statistical Books. The gravitational value of China’s health spatial network was calculated to establish a network of gravitational relationships. The social network analysis method was used for centrality analysis and spillover effect analysis. Results: A gravity correlation matrix was constructed among provinces by calculating the gravitational value, indicating the spatial relationships of different provinces in the health economic network. Economically developed provinces, such as Shanghai and Jiangsu, are at the center of the health economic network (centrality degree = 93.333). These provinces also play a strong intermediary role in the network and have connections with other provinces. In the CONCOR analysis, 31 provinces are divided into four blocks. The spillover effect of the blocks indicates provinces with medical resource centers have beneficial effects, while provinces with insufficient resources have obvious spillover effects. Conclusion: There is a significant gap in the geographical distribution of medical resources, and the health economic spatial network structure needs to be improved. Most medical resources are concentrated in economically developed provinces, and these provinces’ positions in the health economic spatial network are becoming more centralized. By contrast, economically underdeveloped regions are at the edge of the network, causing patients to move to provinces with medical resource centers. There are health risks of the increasing pressure to seek medical treatment in developed provinces with abundant medical resources.

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The disequilibrium in the distribution of the primary health workforce among eight economic regions and between rural and urban areas in China

Cited by 59 publications

References 13 publications

Equity and efficiency of health care resource allocation in Jiangsu Province, China

Equity and efficiency of health care resource allocation in Jiangsu Province, China

Is the allocation of medical and health resources effective? Characteristic facts from regional heterogeneity in China

Regional Disparity and Patients Mobility: Benefits and Spillover Effects of the Spatial Network Structure of the Health Services in China

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