Trend in distribution of primary health care professionals in Jiangsu province of eastern China

International Journal for Equity in Health

Ling Zhou³  Dan Wang³  Kaijin Zhang¹  Kang Xu² 

[1] School of Public Health, Southeast University, 87 Dingjia Bridge, Nanjing 210009, Jiangsu, China;Department of Medical Administration, Huai’an First People’s Hospital, Nanjing Medical University, 6 Beijing West Road, Huai’an 223300, Jiangsu, China;Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, 818 Tianyuan East Road, Nanjing 211166, Jiangsu, China

关键词: People’s Republic of China;    Inequality;    Health workforce;    Primary health care;   

Others  :  1146109
DOI  :  10.1186/s12939-014-0117-z

 received in 2014-04-01, accepted in 2014-11-15,  发布年份 2014

【 摘 要 】

Introduction

Since the late 1990s, the Chinese government has carried out several reforms on the primary health care, which is greatly improved but still left much to be desired, especially for the health workforces. The aim of this study was to analyze the number of health workforces and the trends in distribution of health workforces in Jiangsu province of eastern China from 2008 to 2012.

Methods

The time trends in number and distribution of health professionals were compared in study period. Lorenz curves were plotted and Gini coefficient, Atkinson index and Theil index were calculated for inequalities in the distribution of health workforces to population and area.

Results

The number of health workforces increased every year and the inequality in the distribution of health workforces showed a decline trend from 2008 to 2012. After 2009, these trends changed more rapidly. There was the disproportionality between physicians and nurses. The values of three inequality indicators based on area were larger than those based on population.

Conclusion

The health reform in 2009 might play an important role in increasing the number of health workforces and improving the distribution of health workforces in primary health care facilities. The disproportionality between physicians and nurses was related to the shortage of number of nurses.

【 授权许可】

   
2014 Xu et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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【 参考文献 】

• [1]Kruk ME, Porignon D, Rockers PC, Van Lerberghe W: The contribution of primary care to health and health systems in low- and middle-income countries: a critical review of major primary care initiatives. Soc Sci Med 2010, 70:904-911.
• [2]Shi L, Macinko J, Starfield B, Politzer R, Wulu J, Xu J: Primary care, social inequalities and all-cause, heart disease and cancer mortality in US counties: a comparison between urban and non-urban areas. Public Health 2005, 119:699-710.
• [3]The World Health Report 2008: Primary Health Care (Now More Than Ever). WHO, Geneva; 2008.
• [4]Rohde J, Cousens S, Chopra M, Tangcharoensathien V, Black R, Bhutta ZA, Lawn JE: 30 years after Alma-Ata: has primary health care worked in countries? Lancet 2008, 372:950-961.
• [5][http://www.imf.org] webcite World Economic Outlook Database. Available at: []; 2013 (accessed 13.08.25)
• [6]China Statistical Yearbook (2012). National Bureau of Statistics of China, Beijing, CN; 2012.
• [7]Blumenthal D, Hsiao W: Privatization and its discontents–the evolving Chinese health care system. N Engl J Med 2005, 353:1165-1170.
• [8]Wang H, Xu T, Xu J: Factors contributing to high costs and inequality in China’s health care system. JAMA 2007, 298:1928-1930.
• [9]Liu Y, Hsiao WC, Eggleston K: Equity in health and health care: the Chinese experience. Soc Sci Med 1999, 49:1349-1356.
• [10]Macinko J, Starfield B, Shi L: The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998. Health Serv Res 2003, 38:831-865.
• [11]Shi L, Starfield B, Politzer R, Regan J: Primary care, self-rated health, and reductions in social disparities in health. Health Serv Res 2002, 37:529-550.
• [12]Luo Y, Li J, Xu CJ, Zhang W, Xu HQ, Sun YH: Analysis on health human resources in primary health care facilities in Anhui province: 2004–2010. Chin Rural Health Serv Admin 2011, 31:1237-1239. (in Chinese)
• [13]Wang F, Zhu XX, Ding X: Analyzing the status of grassroots health human resources allocation in China and its equity. Chin Health Service Manage 2012, 29:108-110. (in Chinese)
• [14][http://www.jswst.gov.cn/gb/jsswst/tjxx/xgzl/userobject1ai16821.html] webcite Health Department of Jiangsu: Operating Instructions for National Health Statistics and Reporting System. Available at: []; 2007 (accessed 13.05.25) (in Chinese).
• [15]Brown MC: Using Gini-style indices to evaluate the spatial patterns of health practitioners: theoretical considerations and an application based on Alberta data. Soc Sci Med 1994, 38:1243-1256.
• [16]Theodorakis PN, Mantzavinis GD, Rrumbullaku L, Lionis C, Trell E: Measuring health inequalities in Albania: a focus on the distribution of general practitioners. Hum Resour Health 2006, 4:5. BioMed Central Full Text
• [17]Liu ZW: Mesures of inequality distribution of income: a system review. Stat Inform Forum 2003, 18:28-32. (in Chinese)
• [18]Borrell LN, Talih M: A symmetrized Theil index measure of health disparities: an example using dental caries in U.S. children and adolescents. Stat Med 2011, 30:277-290.
• [19]Hann M, Gravelle H: The maldistribution of general practitioners in England and Wales: 1974–2003. Br J Gen Pract 2004, 54:894-898.
• [20]Araar A, Duclos J Y: DASP: Distributive Analysis Stata Package. PEP, CIRPEE and World Bank, Université Laval, 2007
• [21]Ahmad KA, Najafi B, Haghparast-Bidgoli H: Geographic distribution of need and access to health care in rural population: an ecological study in Iran. Int J Equity Health 2011, 10:39. BioMed Central Full Text
• [22]Williams RF, Doessel DP: Measuring inequality: tools and an illustration. Int J Equity Health 2006, 5:5. BioMed Central Full Text
• [23]Ameryoun A, Meskarpour-Amiri M, Dezfuli-Nejad ML, Khoddami-Vishteh H, Tofighi S: The assessment of inequality on geographical distribution of non-cardiac intensive care beds in Iran. Iran J Public Health 2011, 40:25-33.
• [24][http://news.Xinhuanet.com/newscenter/2009-04/06/content_11138803_3.htm] webcite Central Committee of the Communist Party and State Council, People’s Republic of China: The Standing Conference of State Council of China Adopted Guidelines for Furthering the Reform of Health-Care System in Principle. Available at: []; 2009 (Accessed 13.07. 15) (in Chinese)
• [25]Zhao Y, Li X, Zhang YC, He ZF, Song YD, Zhang WD, Cao ZH: Status and effect of two-way referral system in China: a system review. Chin General Pract 2010, 13:3500-3503. (in Chinese)
• [26]Wang HB, Wang ZG, Shan J, Li CX, Zhang SH, Zhang XJ, Zhu Z, Zhang DY, Li ZS: Practice exploration of basic medical system in community. Chin Health Econ 2010, 29:26-28. (in Chinese)
• [27]Isabel C, Paula V: Geographic distribution of physicians in Portugal. Eur J Health Econ 2010, 11:383-393.
• [28]Toyabe S: Trend in geographic distribution of physicians in Japan. Int J Equity Health 2009, 8:5. BioMed Central Full Text
• [29]Zhang KJ, Li SD, Hu XL, Xu T, Jin AN, Zhou M: A survey and analysis on the huamn resources in community health services in Jiangsu province. Chin General Pract 2004, 7:1753-1754. (in Chinese)
• [30]Yao Y, Hou WL, Lu ZX, Li YB, Li XD, Jia LG, Zhang L: The equity analysis of human resource allocation of community health services in the cities of Hubei province. Chin Health Econ 2010, 29:37-39. (in Chinese)
• [31]Gong XG, Hu SL: The equity of standards of health resource allocation within different provinces. Chin Health Econ 2005, 24:26-29. (in Chinese)
• [32]Kiadaliri AA, Hosseinpour R, Haghparast-Bidgoli H, Gerdtham UG: Pure and social disparities in distribution of dentists: a cross-sectional province-based study in Iran. Int J Environ Res Public Health 2013, 10:1882-1894.
• [33]Li CF, Liu XH, Ke SS, Tu YQ, Lu ZX: Analysis on the fairness of the human resources of the primary health services in Wuhan city. J Pub Health Prev Med 2013, 24:45-47. (in Chinese)
• [34]Lai YW, Meng QY, Wang WH, Dawa T, Li SP: Equity analysis of medical health resource allocation in three prefectures of Tibet. Chin Health Econ 2013, 32:63-64. (in Chinese)