Incorporating Spatial Statistics into Examining Equity in Health Workforce Distribution: An Empirical Analysis in the Chinese Context.

Bin Zhu,Yue Zhang,Chih-Wei Hsieh

doi:10.3390/ijerph15071309

Abstract

Existing measures of health equity bear limitations due to the shortcomings of traditional economic methods (i.e., the spatial location information is overlooked). To fill the void, this study investigates the equity in health workforce distribution in China by incorporating spatial statistics (spatial autocorrelation analysis) and traditional economic methods (Theil index). The results reveal that the total health workforce in China experienced rapid growth from 2004 to 2014. Meanwhile, the Theil indexes for China and its three regions (Western, Central and Eastern China) decreased continually during this period. The spatial autocorrelation analysis shows that the overall agglomeration level (measured by Global Moran’s I) of doctors and nurses dropped rapidly before and after the New Medical Reform, with the value for nurses turning negative. Additionally, the spatial clustering analysis (measured by Local Moran’s I) shows that the low–low cluster areas of doctors and nurses gradually reduced, with the former disappearing from north to south and the latter from east to west. On the basis of these analyses, this study suggests that strategies to promote an equitable distribution of the health workforce should focus on certain geographical areas (low–low and low–high cluster areas).

Highlights

Health equity is an important issue in health management and a crucial concern for policy makers, as it involves various aspects of the health discipline and heated exchanges are generated when health needs are confronted by resource constraints [1,2,3,4]
Health workforce distribution pertains to the distribution and organization of members of the health workforce among health care departments or regions, which can reflect the degree of health equity [5]
This study aims to evaluate the equity of health workforce distribution in China using traditional economic methods and spatial statistics

Summary

Introduction

Health equity is an important issue in health management and a crucial concern for policy makers, as it involves various aspects of the health discipline and heated exchanges are generated when health needs are confronted by resource constraints [1,2,3,4]. Health workforce distribution pertains to the distribution and organization of members of the health workforce among health care departments or regions, which can reflect the degree of health equity [5]. It is widely recognized that health equity is commonly divided into horizontal and vertical dimensions; the former refers to equal treatment for people with equal needs, and the latter emphasizes different levels of treatments for people with unequal needs [6]. Almost all the theoretical or empirical studies concerning health equity, as well as the equity in health workforce distribution, have advocated the horizontal rather than the vertical dimension [7,8]. Kreng and Yang [7] defined an ideal distribution of health workforce as a condition where most people have equal access to health services despite geographical and/or economical differences. The World Health Organization (WHO) [9] proposed accelerating progress toward achieving sustainable development goals by ensuring equitable access to the health workforce

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Discussion

Conclusion