Inequality trends of health workforce in different stages of medical system reform (1985-2011) in China

Human Resources for Health

Min Yu³  Zhou Lu⁴  Duolao Wang²  Yi Ding⁵  Xinyi Zhang¹  Kaiyuan Zhou⁶ 

[1] Department of Otolaryngology, Xi’an Children Hospital, Xi’an, Shaanxi Province, China;Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK;Department of Health Services, Academy of Military Medical Sciences, Beijing, China;Department of Health Services, Fourth Military Medical University, Xi’an, Shaanxi Province, China;Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, China;Department of Aerospace Health Services, Fourth Military Medical University, Xi’an, Shaanxi Province, China

关键词: Medical system reform;    Health workforce;    Inequality;   

Others  :  1235431
DOI  :  10.1186/s12960-015-0089-0

 received in 2014-10-11, accepted in 2015-11-15,  发布年份 2015

【 摘 要 】

Introduction

The aim of this study was to identify whether policies in different stages of medical system reform had been effective in decreasing inequalities and increasing the density of health workers in rural areas in China between 1985 and 2011.

Methods

With data from China Health Statistics Yearbooks from 2004 to 2012, we measured the Gini coefficient and the Theil L index across the urban and rural areas from 1985 to 2011 to investigate changes in inequalities in the distributions of health workers, doctors, and nurses by states, regions, and urban-rural stratum and account for the sources of inequalities.

Results

We found that the overall inequalities in the distribution of health workers decreased to the lowest in 2000, then increased gently until 2011. Nurses were the most unequally distributed between urban-rural districts among health workers. Most of the overall inequalities in the distribution of health workers across regions were due to inequalities within the rural-urban stratum.

Discussions and conclusions

Different policies and interventions in different stages would result in important changes in inequality in the distribution of the health workforce. It was also influenced by other system reforms, like the urbanization, education, and employment reforms in China. The results are useful for the Chinese government to decide how to narrow the gap of the health workforce and meet its citizens’ health needs to the maximum extent.

【 授权许可】

   
2015 Zhou et al.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]The World Health Report 2006. World Health Organization, Geneva; 2006.
• [2]Narasimhan V, Brown H, Pablos-Mendez A, Adams O, Dussault G, Elzinga G et al.. Responding to the global human resources crisis. Lancet. 2004; 363:1469-1472.
• [3]Zhang D, Unschuld PU. China’s barefoot doctor: past, present, and future. The Lancet. 2008; 372:1865-1867.
• [4]The World Health Report 2000-health systems: improving performance. World Health Organization, Geneva; 2001.
• [5]Chen Z. Launch of the health-care reform plan in China. Lancet. 2009; 373:1322-1324.
• [6]Zou D, Ouyang R. Blue book of development and reform: report on Chinese economic development and institutional reform-China:30 years of reform and opening-up(1978-2008). Beijing: Social Sciences Academic Press; 2008.
• [7]Hsiao WC, Liu Y. Economic reform and health--lessons from China. N Engl J Med. 1996; 335:430-432.
• [8]Bhattacharyya O, Delu Y, Wong ST, Bowen C. Evolution of primary care in China 1997–2009. Health Policy. 2011; 100:174-180.
• [9]Ministry of Personnel of P. R. of CHINA. Interim measures of state unassigning jobs for college graduates. 1996-01-09.
• [10]Wang L, Liu J, Chin DP. Progress in tuberculosis control and the evolving public-health system in China. Lancet. 2007; 369:691-696.
• [11]Dussault G, Dubois C-A. Human resources for health policies: a critical component in health policies. Hum Resour Health. 2003; 1:1. BioMed Central Full Text
• [12]Zhang Q, Wu S, Fang P. Analysis by fish bone diagram on human resources flow in community health service institutions in China. Medicine and Society. 2012; 25(4):4.
• [13]Zurn P, Dal Poz MR, Stilwell B, Adams O. Imbalance in the health workforce. Hum Resour Health. 2004; 2:13. BioMed Central Full Text
• [14]International migration of health personnel: a challenge for health systems in developing country. World Health Organization, Geneva; 2004.
• [15]Liu Y, Hsiao WC, Eggleston K. Equity in health and health care: the Chinese experience. Soc Sci Med. 1999; 49:1349-1356.
• [16]Gao J, Tang S, Tolhurst R, Rao K. Changing access to health services in urban China: implications for equity. Health Policy Plan. 2001; 16:302-312.
• [17]Gao J, Qian J, Tang S, Eriksson B, Blas E. Health equity in transition from planned to market economy in China. Health Policy Plan. 2002; 17:20-29.
• [18]Guo L, Huang Z. Discussion on equity of urban-rural health human resources distribution and policy. Health Economics Research. 2007; 8:22-24.
• [19]Zhang X, Lv Z, Wang X et al.. Analysis on policy recommendation for the allocation fairness of village health human resource: case study on field observation of the village clinic of District M in Beijing. Medicine and Philosophy. 2013; 34:62-67.
• [20]Yao Y, Hou W, Lu Z. The equity analysis of human resource allocation of community health services in the cities of Hubei Province. Chinese Health Economic. 2010; 29:37-39.
• [21]Zhang B, Liu J, He Z. Research on Chinese rural health human resource allocation problems and optimization strategies. Medicine and Philosophy. 2013; 34:59-61.
• [22]Wang W, Yang W, Yin A. Analysis of barrier of rural health workforce building based on WHO health workforce strategy target. Chinese Health Economics. 2012; 31:40-42.
• [23]Mu D, Wang Y, Chen X, Chen J, Cui Z, Bao J. Studying on the prior development strategy of health human resources based on health system reform and innovation. Chinese Health Service Management. 2011; 11:804-806.
• [24]Anand S, Fan VY, Zhang J, Zhang L, Ke Y, Dong Z et al.. China’s human resources for health: quantity, quality, and distribution. The Lancet. 2008; 372:1774-1781.
• [25]Anand S. Measuring health workforce inequalities: methods and application to China and India. World Health Organization, Geneva; 2010.
• [26]Sousa A, Poz MRD, Carvalho CL. Monitoring inequalities in the health workforce: the case study of Brazil 1991–2005. PLoS One. 2012; 7: Article ID e33399
• [27]Pallikadavath S, Singh A, Ogollah R, Dean T, Stones W. Human resource inequalities at the base of India’s public health care system. Health Place. 2013; 23:26-32.
• [28]Ministry of Health. China Health Statistics Yearbook. Beijing: China Union Medical University Press; 2004-2012.
• [29]Litchfield J. Inequality methods and tools, text for World Bank’s site on inequality, poverty and socio-economic performance. Internet file retrieved from http://www.worldbank.org in, 1999.
• [30]Folland S, Goodman A C, Stano M. The economics of health and health care (sixth edition). New Jersey: Pearson Prentice Hall; 2007.
• [31]Guilbert J. The World Health Report 2006: working together for health. 9th ed. Education for health, Abingdon, England; 2006.
• [32]Chan H, Zhou L. Structure analysis of China’s public health inequality. Chinese Journal of Population Science. 2011; 6:12.
• [33]Wang D, He Y. The essence, versatility, and policy implications of the gap between urban and rural areas. China Rural Survey. 2005; 3:25-37.
• [34]China Development Report 2001. China Statistics Press, Beijing; 2001.
• [35]Lin JY. Economic development and transition: thought, strategy, and viability. New York: Cambridge University Press; 2009.
• [36]Yip W, Eggleston K. Addressing government and market failures with payment incentives: hospital reimbursement reform in Hainan, China. Soc Sci Med. 2004; 58:267-277.
• [37]China Statistics Yearbook 2000. China Statistics Press, Beijing; 2000.
• [38]Xi’an People’s Government. Xi’an people’s government on printing of Xi’an interim measures for urban residents basic medical insurance. (Xi’an people’s government ed. Xi’an; 2007-10-22.
• [39]Dussault G, Franceschini MC. Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Hum Resour Health. 2006; 4:12. BioMed Central Full Text
• [40]Dolea C, Stormont L, Braichet J-M. Evaluated strategies to increase attraction and retention of health workers in remote and rural areas. Bull World Health Organ. 2010; 88:379-385.
• [41]Council S. Notice of the State Council on issuing key implementation plan of the medical health system reform (2009-2011). 2009.
• [42]Hesketh T, Wu D, Mao L, Ma N. Violence against doctors in China. BMJ. 2012; 345: Article ID e5730
• [43]Xu X, LU R-r. Violence and mistrust: research on violence in medical treatment in transforming China (2000 ~ 2006). Law and Social Development. 2008; 1:82-101.
• [44]World Health Statistics 2010. World Health Organization, Geneva; 2011.
• [45]Kanchanachitra C, Lindelow M, Johnston T, Hanvoravongchai P, Lorenzo FM, Huong NL et al.. Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services. The Lancet. 2011; 377:769-781.
• [46]Song Y, Bian Y: Study on the inter-regional equity in the distribution of doctors in China Mainland:1989~2008. Medicine and Philosophy. 2011;32:70-74.
• [47]Ministry of Health of P. R. of CHINA. Notice of the General Office of the Ministry of Health on organizing the implementation of health personnel training project in West Region. (Ministry of Health ed.; 2006-09-03.