The Allocation And Equity Of Personnel And Facilities Of Radiotherapy In The County Hospitals In 27 Provinces Of China In 2019

Objective To examine the status of personnel and facilities of radiotherapy in county hospital of mainland and to evaluate the equity of allocation,provide corresponding reference for optimizing the allocation of county-level radiotherapy resources.Method All the county-level radiotherapy units in 27 Provinces in China were chosen for study,the data were extracted from the 9^th national survey on radiation oncology departments conducted by Chinese Society of Radiation Oncology of Chinese Medical Association from April 10,2019 to September 20,2019.Descriptive statistics and statistical analysis were performed.For the further analysis on the equity,the Gini coefficient,Theil index and agglomeration degree were calculated.Result（1）There were 422 county-level radiotherapy units in China mainland,191in the eastern region,172 in the central region and only 59 in the western region,there was no radiotherapy unit in the county area of some provinces in the western region.For the counties with larger population（population over 50 million）in mainland,23.4%of the counties in the western region had radiotherapy units,compared to eastern region（48.9%）and central region（41.8%）.（2）The number of radiotherapy physicians per million population in central region was 7.18,lower than that in eastern and western region（8.92,9.08）.The proportion of radiotherapy physicians with master’s degree（24.51%）and doctor’s degree（2.48%）in eastern China was higher than that in central and western region.There were 436 medical linear accelerators（foreign brands accounted for 69.5%）,18 cobalt-60 therapeutic machines,290 X-ray simulators and109 CT simulators in County-level radiotherapy units.（3）The Gini coefficients of all kinds of radiotherapy health resources according to population allocation were all in the range of 0.4-0.6,which was in a state of alert,and the Gini coefficients according to geographical allocation were over 0.7,which were in highly unfair status.The intra-regional gap in radiotherapy resource allocation was larger than the inter-regional gap.HRAD,HRAD/PAD in the eastern and central regions were all greater than 1,while those in the western regions were all less than 1.The concentration indexes of personnel and facilities configuration of county-level radiotherapy units in mainland were less than 0 except for radiotherapy physicians and radiotherapy technicians.The configuration of radiotherapy physicians and technicians was more inclined to the regions with higher economic levels.Conclusion The overall configuration of county level radiotherapy units in Chinese mainland is insufficient,the coverage of county-level radiotherapy units is low,and there is a regional difference.The structure of radiotherapy personnel is more reasonable,however,highly educated medical staff are more concentrated in the economically developed region.County-level radiotherapy units need to introduce more new precision radiotherapy technologies,the simulators for precision radiotherapy is insufficient.The fairness of geographical allocation of radiotherapy resources is generally poor.Radiotherapy resources should be scientifically configured to improve the fairness of radiotherapy resource distribution.