Study On The Distribution Equity Of Doctors、Nurses And Medical Beds In Mainland China

Objective:To analyze the distribution equity of health resources (doctors, nurses and medical beds) in 31 provinces of mainland China during these 36 years of China’s reform and opening up and to provide evidences on improving public policies on health resources planning and equity.Contents:The theories and the methods of distribution equity of health resources were reviewed; The development of health resources (doctors, nurses and medical beds)in China was described; The distribution equity of health resources (doctors, nurses and medical beds) in mainland China was evaluated during the period 1978 to 2013; And policy and research suggestions were offered thereby.Methods:The current research on health resources distribution equity at home and abroad was summarized in this study, as well as the theories and the methods of distribution equity of health resources were described by means of literature review; Box-plot and Tableau Public was applied to analyze the development status of China’s health resources; Lorenz curve, Gini coefficient and Equity Index were applied to analyze the distribution equity and its change tendency of doctors, nurses and medical beds in mainland China during the period 1978 to 2013.Results:The theories and methods of distribution equity of health resources were describes in this paper. The allocation of health resources should pay attention to the balance of total supply and total demand, insist on the combination of equity and efficiency, stress on the basis of needs and demand. There are many methods for evaluating the distribution equity of health resources, but these methods have some drawbacks of complicated running, poor operation and difficult to implement Based on the above research and combined with the Gini coefficient, the traditional classical method, equity index to evaluate the equity of health resource allocation was tried to used in this paper.The basic condition of China’s health resources. There is a great development in China’s total health resources since reform and opening-up. The medical beds increased from 2.01 million in 1978 to 6.18 million in 2013, the growth rate rises dramatically to 207.46%; The total of doctors and nurses is 1.4561 million people in 1978, and this number increased to 5.5779 million people in 2013, the increase is nearly more than threefold. Meanwhile, the health resources per capita had increased steadily. The medical bed number of per 1000 people from 2.15 in 1978 rose to 4.55 in 2013, the doctors and nurses number of per 1000 people from 1.10 to 2.06 and 0.42 to 2.05, respectively, during these years. However, there is still a comparative gap between China and developed countries. The health resources distribution has differences in different regions. Due to the highly populated coastal regions of China, the medical bed number of per 1000 people has relatively small number. The medical bed number of per 1000 people in Xinjiang, Liaoning, Heilongjiang, Sichuan, Chongqing and other provinces have already exceeded the number in Beijing and Shanghai, it also changed the leading situation of Beijing and Shanghai. However, the ownership of doctors and nurses of per 1000 people in Tibet, Gansu, Yunnan and other provinces are still low. The per capita of developed city, such as Beijing, Shanghai, Tianjin and etc, are still in the leading position.The empirical research results of the distribution equity in China. Since 36 years of reform and opening-up, the Gini coefficient of medical beds by population distribution in mainland China had declined, from 0.164 in 1978 to 0.067 in 2013. The Gini coefficient by death population distribution had declined, from 0.166 in 1978 to 0.077 in 2013. The equity index by population distribution had declined, from 1.103 to 1.014. The equity index by death population distribution had declined, from 1.127 to 1.022.The Gini coefficient of doctors by population distribution in mainland China had declined, from 0.188 in 1978 to 0.083 in 2013. The Gini coefficient by death population distribution had declined, from 0.203 in 1978 to 0.123 in 2013. The equity index by population distribution had declined, from 1.153 to 1.026. The equity index by death population distribution had declined, from 1.183 to 1.062. The Gini coefficient of nurses by population distribution in mainland China had declined, from 0.278 in 1978 to 0.094 in 2013. The Gini coefficient by death population distribution had declined, from 0.300 in 1978 to 0.136 in 2013. The equity index by population distribution had declined, from 1.450 to 1.035. The equity index by death population distribution had declined, from 1.512 to 1.077. These results indicate that the distribution equity of medical beds, doctors and nurses in China has been improved.Discussions:Nowadays, the distribution equity of doctors、nurses and medical beds in Mainland China has been improved. External influence factors of these improvements are probably national strategies of regional balanced development, such as East Takes the Lead in Development, China Western Development, Rise of Central China and Northeast Area Revitalization Plan. Meanwhile, internal influencing factors may be followed by some government policies, such as the basic health organization, regional health plans, medical education career developments and the medical-sanitary system reformation.Medical beds can be acquired in hospitals by themselves or government subsidies, but cannot get medical personnel via simple purchases, for doctors or nurses decide which region they work by themselves.The fairness index model was used to evaluation of provincial distribution fairness of the numbers of doctors, nurses and medical beds in our study and the accuracy, simple, feasible and high sensitivity of the model were proved. Furthermore, this model can be used in resource distribution fairness studies, which assist the health macro management and decision making.Suggestions:To give full play to the leading role in the allocation of health resources, the supervision of the macroeconomic regulation and control, planning, investment, and the system construction should be strengthened by governments. To keep the health fairness, the health input to the particular regions should be increased and the resources flow to the medical shortage provinces and regions should be leaded and the nurse resources configuration by training, guidance, incentive measures should be optimized by the government. Suggestibly, in order to get more comprehensive information fairness, time series analysis perspective might be a proper way.