| Objective This study aims to analyse the current situation of health resource allocation in Jiangsu Province by reviewing the health manpower,material resources and financial resources in Jiangsu Province since the new health care reform.This study specifically analyses the main problems from the perspective of fairness and allocation efficiency.What’s more,it predicts the development trend of health resources in the next few years.And then,based on the analysis and summary,the possible methods and suggestions for further optimizing the efficiency and fairness of health resource allocation will be put forward.Finally,it will provide theoretical and methodological support for promoting the construction of "healthy Jiangsu".Methods It uses descriptive statistical analysis to analyze the allocation status of various health resources in Jiangsu Province.It uses Gini coefficient,Theil index and agglomeration degree to dynamically analyze its allocation fairness.It uses Data Envelopment Analysis to compare the effectiveness of resource allocation in Jiangsu Province in 2017.It uses Malmquist index to compare the effectiveness of resource allocation in 2009-2017 vertically.Based on GM(1,1),it predicts whether the development of health resources in Jiangsu Province will meet the established policy requirements by 2020.Results1.Current situation analysis shows that:(1)Between 2009 and 2017,the total number of health workers increased from 436,900 to 69,280,000,an increase of 58.57%,an average annual growth of 5.93%.Among them,there are 21725 Practicing(assistant)physicians and 237 156 registered nurses,with a ratio of 1:1.09.The number of health technicians,practicing(assistant)doctors and registered nurses per 1,000 population has reached 6.82,2.71 and 2.95 respectively,which are higher than the national average in the same period.And the level of health workers per 1,000 population is as follows:southern Jiangsu>Northern Jiangsu>Central Jiangsu.(2)By the end of 2017,the total number of health institutions in Jiangsu Province is 32037,and the number of health beds is 469805.The total number of health institutions is North Jiangsu,South Jiangsu and C entral Jiangsu.The number of health institutions per unit area is South Jiangsu>Central Jiangsu>North Jiangsu.The total number of health beds and the number of beds per unit population are in the order of South Jiangsu>North Jiangsu>Central Jiangsu.(3)From 2009 to 2017,the financial subsidy income and total health expenditure of health institutions in Jiangsu Province increased year by year.By 2017,the government’s financial subsidy income is 325,598,468,000 yuan.Five cities in southern Jiangsu accounts for 60.91%.The three cities in central Jiangsu accounts for 17.26%.Five cities in northern Jiangsu accounts for 21.83%.Total expenditure of health institutions.The total expenditure of health institutions is 26805,247.7 million yuan,with different increases in different cities.Among them,Nanjing and Suzhou have a larger base of total health expenditure and a larger growth,while Suqian and Lianyungang have a smaller base of total health expenditure and a smaller growth rate.2.Equity of allocation:(1)Human resource equity.The Gini coefficient and Theil index based on population dimension are 0.0448-0.1438 and 0.0018-0.0114 respectively.The Gini coefficient and Theil index based on geographical latitude are 0.2398-0.3230 and 0.0396-0.0742 respectively.The degree of fairness is as follows:practicing physicians>health technicians>registered nurses,and the inequity is mainly caused by regional differences.From the perspective of agglomeration degree,health resources allocation fairness in the population and geographical level is higher in southern Jiangsu;registered nurses allocation fairness is relatively low in central Jiangsu according to the population dimension;health resources allocation fairness in the population and geographical level is lower in northern Jiangsu.(2)Equity of material resources.Gini coefficient and Theil index based on population dimension are 0.0464-0.1688 and 0.0016-0.0203 respectively.Gini coefficient and Theil index based on geographical latitude are 0.1406-0.3245 and 0.0141-0.0766 respectively.The degree of fairness shows that the number of beds in health institutions is higher than the number of health institutions.Moreover,at the demographic level,the unfairness of the number of health facilities is due to inter-group differences,and the unfairness of the number of beds is due to intra-group differences,while at the geographical level,the opposite is true.In terms of agglomeration degree,the fairness of the number of health institutions in terms of population dimension is relatively low,while the fairness of other resources in terms of population and geography is relatively high.The fairness of beds by population dimension is relatively low in central Jiangsu,and there are differences in the fairness by geographical latitude.The fairness of beds by population dimension is relatively low in central Jiangsu,and there are differences in the fairness by geographical latitude.The equity of health institutions in terms of population dimension is relatively high in northern Jiangsu,while the equity of other resources in terms of population and geographical latitude is relatively low.(3)Fairness of financial resources.Gini coefficient Theil index based on population dimension is 0.2029-0.3306 and 0.0285-0.0837 respectively.Gini coefficient and Theil index based on geographical latitude are 0.3895-0.4875 and 0.1093-0.1851 respectively.The fairness degree is shown as total expenditure>financial subsidy.And inequity is mainly caused by regional differences.From the perspective of agglomeration degree,health resources allocation fairness in the population and geographic level is higher in southern Jiangsu;total expenditure fairness in central Jiangsu is relatively low in terms of population dimension;health resources allocation fairness in the population and geographic level is lower in northern Jiangsu.3.Allocation efficiency:(1)The number of medical institutions in our province and cities increased year by year.By 2017,the total number of medical institutions in the province was 58.43724 million.In terms of the utilization of beds,the number of beds turnover in 2017 was 32.2 times,an increase of 3.2 times compared with 2009.The working day of beds has decreased from 338.2 days in 2009 to 319.2 days in 2017.The utilization rate of sickbeds in the whole province was 87.45%.The overall performance was declining,and the difference between regions was obvious.(2)Comparing the resource allocation efficiency of Jiangsu Province in 2017 horizontally,there are 6 DEA efficient cities,3 weak effective cities and 4 DEA ineffective cities.Moreover,the average comprehensive efficiency of non-DEA effective cities is 0.959,and the overall efficiency of health resource allocation in Jiangsu Province is relatively high.(3)Longitudinally comparing the resource allocation efficiency of the whole province from 2009 to 2017,the average total factor of production is 0.942.Besides,the average total factor of production in the whole year except 2010 is less than 1,which indicates that the efficiency of health resource allocation in the whole province has a negative growth.By decomposing the total factors,we can see that the decline of technological efficiency leads to the decrease of TFP.4.Resource Forecast:Based on GM(1,1)model,by 2020,the permanent population of Jiangsu Province will reach 80.914 million,the number of practicing(assistant)doctors will reach 26,2411,the number of registered nurses will reach 29,2081,and the number of beds in health institutions will reach 56,3785.Combining with the established policy objectives,the whole province generally will meet the target requirements of health resources.Specifically to the cities of Jiangsu Province,the number of registered nurses and institutional beds in some cities can not meet the requirements according to the current growth trend.conclusionFrom the point of view of allocation status,the total amount of health human resources is increasing year by year,but the number of health personnel per 1,000 population varies greatly among regions,and the overall health care ratio is still very low;the geographic accessibility of residents in different regions has a certain gap;some medical resources are excessively concentrated in high-level medical institutions or cities.From the perspective of allocation fairness,the overall level of health resources allocation is higher,population fairness is better than geographical fairness,and the degree of inequity is greatly affected by regional differences.The resource allocation of the provincial cities is characterized by the coexistence of surplus and shortage.From the perspective of allocation efficiency,horizontal comparison shows that the overall allocation level of the province at this stage is higher,there is Pareto improvement;vertical comparison shows that the allocation efficiency of the province shows negative growth,and the reduction of productivity level is mainly caused by the decline of technology level.From the model forecast,by 2020,the overall allocation level of health resources in the province can meet the requirements of policy objectives,but specific to the cities,some cities are obviously insufficient in the allocation of resources in the expectation.Therefore,in order to further improve the allocation level of health resources in Jiangsu Province,it is necessary to optimize the relevant human resources system in order to form a rational and orderly distribution of talents.It is necessary to strengthen the leading role of the government and play an active role in the market.It is necessary to further optimize the stock of health resources and actively adjust the incremental allocation of resources.Effective implementation of graded diagnosis and treatment is needed to deepen the reform of health system.Equity and efficiency should be taken into account in order to promote the sustainable development of health resource allocation. |
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