Abstract
Background: Although China began implementing medical reforms in 2009 aimed at fair allocation of the regional distribution of doctors, little is known of their impact. This study analyzed the geographic distribution of doctors from 2002 to 2017. Methods: This study calculated the Gini coefficient and Theil index among doctors in the eastern, central, and western regions (Category 1) of China, and in urban and rural areas (Category 2). The statistical significance of fairness changes was analyzed using the Mann–Whitney U test. Results: The annual growth rates of the number of doctors for the periods from 2002 to 2009 and 2010 to 2017 were 2.38% and 4.44%. The Gini coefficients among Category 1 were lower than those in Category 2, and statistically decreased after the medical reforms (P < 0.01) but continued to increase in Category 2 (P = 0.463). In 2017, the Theil decomposition result of Category 1 was 74.33% for the between-group, and in Category 2, it was 95.22% for the within-group. Conclusions: The fairness among the regional distribution of doctors in Category 1 is now at a high level and is better than that before the reforms. While the fairness in Category 2 is worse than that before the reforms, it causes moderate inequality and is continually decreasing. Overall unfairness was found to be derived from the between-group.
Highlights
Fairness reflects equal social relations and is a common ideal in human society [1,2]
The World Health Organization claims that a commitment to equity is a core element of the primary health care value system and that the right to life-saving and health-promoting interventions must not be denied for any reason [7]
We found that the change in Gini coefficient for Category 1 was statistically significant for both periods (P < 0.001)
Summary
Fairness reflects equal social relations and is a common ideal in human society [1,2]. The fair allocation of health resources means that every member of society has the same rights to health care services [5]. This entails that there are no related differences between geographically defined populations and that all health care resources are reasonably allocated based on individual health care needs [6]. China began implementing medical reforms in 2009 aimed at fair allocation of the regional distribution of doctors, little is known of their impact. Methods: This study calculated the Gini coefficient and Theil index among doctors in the eastern, central, and western regions (Category 1) of.
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