Differences in regional distribution and inequality in health-resource allocation on institutions, beds, and workforce: a longitudinal study in China

Abstract Background The distribution of health-care resources is foundational to achieving fairness and having access to health service. China and its local Shanghai’s government have implemented measures to allocate health-care resources with the equity as one of the major goals since 2009-health-care reform. The aim of this study was to analyze differences in regional distribution and inequality in health-resource allocation on institutions, beds, and workforce in Shanghai over 7 years. Methods The study was conducted using 2010–2016 data to analyze health-resource allocation on institutions, beds, and workforce in Shanghai, China. The annual growth rate (AGR) was used to evaluate the time trends of health-care resource from 2010 to 2016, and Theil index was calculated to measure inequality of five indicators of health-care resource allocation during this study period. Results All quantities of health-care resources per 1000 people increased across Shanghai districts from 2010 to 2016. Compared with suburban districts, the central districts had higher ratios on five health-care resource indicators, and faster average growth in the bed and nurse indicator. The Theil of the indicators, except for doctors in hospitals, all exhibited downward time trends. Conclusions Regional difference between urban and rural areas and inequality between institution and workforce, especially for doctors, still existed. Some targeted measures including but not limited to income raising, facilitation of transportation conditions, investment of more fiscal funds, enhancement of health-care service provision for rural residents should be fully considered to narrow resource distribution gap between urban and rural districts and mitigate the inequality of health-care resource allocation.

Download Full-text

Differences in Regional Distribution and Inequality in Health-Resource Allocation on Institutions, Beds, and Workforce: A Longitudinal Study in Shanghai, China

10.21203/rs.3.rs-62172/v1 ◽

2020 ◽

Author(s):

Enhong Dong ◽

Xiaoting Sun ◽

Lufa Zhang ◽

Minjie Chen ◽

Hongmei Wang ◽

...

Keyword(s):

Health Care ◽

Resource Allocation ◽

Rural Areas ◽

Regional Distribution ◽

Theil Index ◽

Health Resource ◽

Average Growth ◽

Health Care Resources ◽

Health Resource Allocation ◽

Inequality In Health

Abstract Background: The distribution of health-care resources is a critical component of health-care access, and equity is a basic principle of health-resource allocation, and foundational to achieving fairness in the provision of health services. China and its local Shanghai’s government has implemented measures to allocate health-care resources with the equity as one of the major goals since 2009.The aim of this study was to analyze differences in regional distribution and inequality in health-resource allocation on institutions, beds, and workforce in Shanghai over 7 years.Methods: A longitudinal survey using 2010–2016 data, which were collected for analysis. The study was conducted health-resource allocation on institutions, beds, and workforce in Shanghai, China. Five health-resource indicators were used to measure health-resource distribution at the city and district levels. Furthermore, the Theil index was calculated to measure inequality of health-resource allocation.Results: All quantities of health-care resources per 1000 people increased across Shanghai districts from 2010 to 2016. Compared with suburban districts, the central districts had higher ratios on five health-care resource indicators, and faster average growth in the bed and nurse indicator, and slower growth in the institution, technician and doctor indicator. The Theil indices of the technicians, doctors, nurses and beds had higher values than that of institutions every year from 2010 to 2016; furthermore, the Theil indices of the indicators, except for doctors in hospitals, all exhibited downward time trends.Conclusions: Increased health-care resources and reduced inequality of health-resource allocation in Shanghai during the 7 years indicated that the measures taken by the Shanghai government in the new round of healthcare reform in China since 2009 had been successful. Meanwhile there still existed regional difference between urban and rural areas and inequality between institution and workforce, especially doctors.

Download Full-text

Differences in regional distribution and inequality in health-resource allocation at hospital and primary health centre levels: a longitudinal study in Shanghai, China

BMJ Open ◽

10.1136/bmjopen-2019-035635 ◽

2020 ◽

Vol 10 (7) ◽

pp. e035635

Author(s):

Enhong Dong ◽

Shipeng Liu ◽

Minjie Chen ◽

Hongmei Wang ◽

Li-Wu Chen ◽

...

Keyword(s):

Resource Allocation ◽

Health Centre ◽

Regional Distribution ◽

Primary Health Centre ◽

Theil Index ◽

Health Resource ◽

Healthcare Resources ◽

Health Resource Allocation ◽

Primary Health ◽

Inequality In Health

ObjectivesTo analyse differences in regional distribution and inequality in health-resource allocation at the hospital and primary health centre (PHC) levels in Shanghai over 7 years.DesignA longitudinal survey using 2010–2016 data, which were collected for analysis.SettingThe study was conducted at the hospital and PHC levels in Shanghai, China.Outcome measuresTen health-resource indicators were used to measure health-resource distribution at the hospital and PHC levels. In addition, the Theil Index was calculated to measure inequality in health-resource allocation.ResultsAll quantities of healthcare resources per 1000 people in hospitals and PHCs increased across Shanghai districts from 2010 to 2016. Relative to suburban districts, the central districts had higher ratios, both in terms of doctors and equipment, and had faster growth in the doctor indicator and slower growth in the equipment indicator in hospitals and PHCs. The Theil Indices of all health-resource allocation in hospitals had higher values compared with those in PHCs every year from 2010 to 2016; furthermore, the Theil Indices of the indicators, except for technicians and doctors in hospitals, all exhibited downward time trends in hospitals and PHCs.ConclusionsIncreased healthcare resources and reduced inequality of health-resource allocation in Shanghai during the 7 years indicated that measures taken by the Shanghai government to deepen the new round of healthcare reform in China since 2009 had been successful. Meanwhile there still existed regional difference between urban and rural areas and inequality across different medical institutions. To solve these problems, we prescribe increased wages, improved working conditions, and more open access to career development for doctors and nurses; reduced investments in redundant equipment in hospitals; and other incentives for balancing the health workforce between hospitals and PHCs.

Download Full-text

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

International Journal for Equity in Health ◽

10.1186/s12939-020-01320-2 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Qian Li ◽

Jianjun Wei ◽

Fengchang Jiang ◽

Guixiang Zhou ◽

Rilei Jiang ◽

...

Keyword(s):

Health Care ◽

Resource Allocation ◽

Geographical Area ◽

Health Care Resource ◽

Jiangsu Province ◽

Financial Resources ◽

Health Resource ◽

Statistical Yearbook ◽

Efficiency And Productivity ◽

Better Than

Abstract 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.

Download Full-text