Abstract
ObjectiveWe aimed to analyze regional disparities of health care resources in traditional Chinese medicine (TCM) county hospitals and their time trends, and to assess the changes of regional disparities before and after 2009 health care reforms.MethodsWe used hospital-based, longitudinal data from all TCM county hospitals in China between 2004 and 2016. To measure the key development features of TCM county hospitals, data were collected on government hospital investment, hospital numbers (the average number of TCM hospitals per county), hospital scale (the number of medical staff and hospital beds) and doctors’ workload (the daily visits and inpatient stays per doctor). We used segmented linear regression to test the time trend for outcome variables. We set a breakpoint at 2011, dividing the pre-reform (2004–2011) and post-reform (2012–2016) periods.ResultsAfter the 2009 health reforms, TCM hospitals continued to display large disparities in the number, scale, and doctors’ workload across the three regions. In the pre-reform period, yearly government subsidies for TCM hospitals in western area were roughly RMB0.6 million (US$89 thousand) more than those in central and eastern region, which increased under the 2009 reforms to roughly RMB2 million (US$298 thousand) more per yer in post-reform period. These increased subsidies saw an increase in the number of TCM hospitals in the western area, partly addressing regional disparities. But there was no improvement in the regional disparities in terms of scale (number of beds) and the doctors’ workload (daily outpatient visits and inpatients per doctor) increased or remained unchanged between the western and other regions.ConclusionAlthough TCM hospital number, scale, and doctors’ workload increased over the past 13 years, substantial regional disparities remained. The 2009 health reforms did not significantly change the regional disparities in health care resources, especially between the eastern and western regions.
Highlights
Regional disparities in health care is a global phenomenon, and a persistent feature of China’s health care system [1]
traditional Chinese medicine (TCM) hospitals were the main Chinese medicine providers that treat the patients with TCM service and products to maintain public health[9,10]
Given China’s cultural heritage, the promotion of TCM has always been a priority in China, with the demand for TCM services increasing in recent years [11]
Summary
Regional disparities in health care is a global phenomenon, and a persistent feature of China’s health care system [1]. Similar to geographical disparities in China’s economic development, provinces in western and central China have much lower densities of health facilities, health workers and hospital beds compared with more developed eastern provinces [6,7,8]. These disparities increased between 1980 and 2003, where the absolute gap in beds per thousand people among eastern, central and western and regions increased [8]. Since 1954, TCM hospitals were initiated by the central government, and treat patients with TCM service and medicine[12]. During 1970s, the China government proposed the policy of “integration of Chinese and western medicine”, and more and more modern medicine and technologies were introduced to TCM hospitals[12]
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