ABSTRACT
This study evaluated the dynamic distribution, regional differences, and convergence of health workforce allocation in Township Health Centers in China during 2011-2020 using data obtained from the China Health Statistics Yearbook (2012-2021). The Gini coefficient and kernel density estimation were chosen to examine the dynamic distribution and regional differences in health workforce allocation in Township Health Centers in China and their components. σ convergence and ß convergence were used to investigate the change trend of health workforce allocation in Township Health Centers. The results show that between 2011 and 2020, the number of licensed doctors and registered nurses per thousand population in Township Health Centers both increased largely and regional disparities still exist. In 2020, the largest differences in the density of licensed doctors and registered nurses were found in the eastern and central regions, respectively, and the intensity of trans-variation contributed the most to the overall disparities. The allocation of licensed doctors and registered nurses both exhibited σ convergence, absolute and conditional ß convergence, indicating that the regional differences in health workforce in THCs among provinces will decrease. The growth of healthcare workforce was positively impacted by the urbanization rate, growth rate of government health expenditures and growth domestic product per capita, but negatively impacted by population density in rural areas and fiscal self-sufficiency.
ABSTRACT
BACKGROUND: As approximately 3/4 of the population lives in county-level divisions in China, the allocation of health resources at the county level will affect the realization of health equity. This study aims to evaluate the disparity in hospital beds at the county level in China, analyze its causes, and discuss measures to optimize the allocation. METHODS: Data were drawn from the Chinese County/City Statistical Yearbook (2001-2020). The health resource density index (HRDI) was applied to mediate between the influence of demographic and geographical factors on the allocation of hospital beds. The trends of HRDI allocation were evaluated through the growth incidence curve and the probability density function. The regional disparity in the HRDI was examined through the Lorenz curve, and Dagum Gini coefficient. The contribution of the Gini coefficient and its change were assessed by using the Dagum Gini decomposition method. RESULTS: From 2000 to 2019, the number of hospital beds per thousand people at the county level in China increased dramatically by 1.49 times. From the aspect of the HRDI, there were large regional disparities at the national level, with a Gini coefficient of 0.367 in 2019 and in the three subregions. In 2019, the Gini coefficient of the HRDI exhibited regional variations, with the highest value observed in the western region, followed by the central region and the eastern region. Decomposition reveals that the contribution of interregional disparity changed from the dominant factor to the least important factor, accounting for 29.79% of the overall disparity and the contribution of trans-variation intensity increased from 29.19% to 39.75%, whereas the intraregional disparity remained stable at approximately 31% and became the second most important factor. CONCLUSION: The regional disparity in hospital beds allocation at the county level in China was large and has not improved substantially. Trans-variation intensity was the main reason for the overall disparity and changes, and the intraregional disparity was more important than the interregional disparity for the overall disparity.
