Abstract
BackgroundThe aging population, rapid urbanization, and epidemiology transition in China call for the improvement and adaptation of the health workforce, especially in underserved rural areas. The aging of village doctors (the former “barefoot doctors”) who have served the rural residents for many decades has become a warning signal for the human resources for health in China. This study aims to investigate the village doctors’ aging situation and its implications in rural China.MethodsThe data reviewed were obtained from the baseline survey of a longitudinal study of rural health workforce in five counties in rural China in 2011. Using a stratified multi-stage cluster sampling process, the baseline data was collected through the self-administered structured Village Doctor Questionnaire. Descriptive analyses, correlation analyses, and multivariate linear regression with interaction terms were conducted with the statistics software Stata 12.0.ResultsThe average age of the 1,927 village doctors was 49.3 years (95% CI 48.8 to 49.9), 870 (45.2%) of whom were aging (50 years or older). Both the age and the recruitment time of the village doctors were demonstrated to have a bimodal distribution. A greater proportion of the male village doctors were aging. Furthermore, aging of the village doctors was significantly correlated to their education level, type of qualification, practicing methods, and their status as village clinic directors (P <0.05, respectively). As shown in the regression models, aging village doctors provided significantly more outpatient services to rural residents (P <0.01) but without an increase in income, and their expected pension was lower (P <0.01), compared with their non-aging counterparts.ConclusionsAging of village doctors is a serious and imperative issue in China, which has a complex and profound impact on the rural health system. Greater attention should be paid to the construction of the pension system and the replenishment of the village doctors with qualified medical graduates.
Highlights
The aging population, rapid urbanization, and epidemiology transition in China call for the improvement and adaptation of the health workforce, especially in underserved rural areas
The healthcare demands of rural China have not decreased in parallel with the decrease in the rural population; on the contrary, such a transition requires rural health facilities to provide more and better healthcare to the remaining rural residents
The fluctuating workforce supply of the village doctors in China In this study, it was found that the aging of village doctors in China is serious and imperative, especially in the developed counties of Changshu and Liyang, which was consistent with the findings from other studies [30,31,35]
Summary
The aging population, rapid urbanization, and epidemiology transition in China call for the improvement and adaptation of the health workforce, especially in underserved rural areas. China is urbanizing at a rapid rate due to the rural-to-urban migration occurring since the post-1978 economic reform. The interaction between population aging and fast urbanization exerts increased pressure on the health system in rural China. The remaining rural residents, mainly the elderly and the very young, have greater healthcare demands than the migrating population. The healthcare demands of rural China have not decreased in parallel with the decrease in the rural population; on the contrary, such a transition requires rural health facilities to provide more and better healthcare to the remaining rural residents
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