TY - JOUR
T1 - Differences in regional distribution and inequality in health-resource allocation at hospital and primary health centre levels
T2 - A longitudinal study in Shanghai, China
AU - Dong, Enhong
AU - Liu, Shipeng
AU - Chen, Minjie
AU - Wang, Hongmei
AU - Chen, Li Wu
AU - Xu, Ting
AU - Wang, Tao
AU - Zhang, Lufa
N1 - Funding Information:
funding This research was funded National Social Science Foundation of China General Project (Grant No. 18BGL242);National Social Science Foundation of China General Project (Grant No. 19BGL246);National Social Science Foundation of China Major Project (Grant No. 18ZDA088);Key Program for Collaborative Innovation of Shanghai University of Medicine & Health Sciences Grant (Grant No. SPCI-18-02-001).The funders had no role in the question design, analysis or interpretation.
Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2020/7/19
Y1 - 2020/7/19
N2 - Objectives To analyse differences in regional distribution and inequality in health-resource allocation at the hospital and primary health centre (PHC) levels in Shanghai over 7 years. Design A longitudinal survey using 2010-2016 data, which were collected for analysis. Setting The study was conducted at the hospital and PHC levels in Shanghai, China. Outcome measures Ten health-resource indicators were used to measure health-resource distribution at the hospital and PHC levels. In addition, the Theil Index was calculated to measure inequality in health-resource allocation. Results All quantities of healthcare resources per 1000 people in hospitals and PHCs increased across Shanghai districts from 2010 to 2016. Relative to suburban districts, the central districts had higher ratios, both in terms of doctors and equipment, and had faster growth in the doctor indicator and slower growth in the equipment indicator in hospitals and PHCs. The Theil Indices of all health-resource allocation in hospitals had higher values compared with those in PHCs every year from 2010 to 2016; furthermore, the Theil Indices of the indicators, except for technicians and doctors in hospitals, all exhibited downward time trends in hospitals and PHCs. Conclusions Increased healthcare resources and reduced inequality of health-resource allocation in Shanghai during the 7 years indicated that measures taken by the Shanghai government to deepen the new round of healthcare reform in China since 2009 had been successful. Meanwhile there still existed regional difference between urban and rural areas and inequality across different medical institutions. To solve these problems, we prescribe increased wages, improved working conditions, and more open access to career development for doctors and nurses; reduced investments in redundant equipment in hospitals; and other incentives for balancing the health workforce between hospitals and PHCs.
AB - Objectives To analyse differences in regional distribution and inequality in health-resource allocation at the hospital and primary health centre (PHC) levels in Shanghai over 7 years. Design A longitudinal survey using 2010-2016 data, which were collected for analysis. Setting The study was conducted at the hospital and PHC levels in Shanghai, China. Outcome measures Ten health-resource indicators were used to measure health-resource distribution at the hospital and PHC levels. In addition, the Theil Index was calculated to measure inequality in health-resource allocation. Results All quantities of healthcare resources per 1000 people in hospitals and PHCs increased across Shanghai districts from 2010 to 2016. Relative to suburban districts, the central districts had higher ratios, both in terms of doctors and equipment, and had faster growth in the doctor indicator and slower growth in the equipment indicator in hospitals and PHCs. The Theil Indices of all health-resource allocation in hospitals had higher values compared with those in PHCs every year from 2010 to 2016; furthermore, the Theil Indices of the indicators, except for technicians and doctors in hospitals, all exhibited downward time trends in hospitals and PHCs. Conclusions Increased healthcare resources and reduced inequality of health-resource allocation in Shanghai during the 7 years indicated that measures taken by the Shanghai government to deepen the new round of healthcare reform in China since 2009 had been successful. Meanwhile there still existed regional difference between urban and rural areas and inequality across different medical institutions. To solve these problems, we prescribe increased wages, improved working conditions, and more open access to career development for doctors and nurses; reduced investments in redundant equipment in hospitals; and other incentives for balancing the health workforce between hospitals and PHCs.
KW - health-care resources
KW - hospital
KW - inequality
KW - primary health center (PHC)
KW - regional difference
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U2 - 10.1136/bmjopen-2019-035635
DO - 10.1136/bmjopen-2019-035635
M3 - Article
C2 - 32690509
AN - SCOPUS:85088460893
SN - 2044-6055
VL - 10
JO - BMJ open
JF - BMJ open
IS - 7
M1 - e035635
ER -