Abstract
BackgroundChina launched a new round of healthcare-system reform in 2009 and proposed the goal of equal and guaranteed essential medical and health services for all by 2020. We aimed to investigate the changes in China’s health resources over the past ten years after the healthcare reform.MethodsData were collected from the China Statistical Yearbook and China Health Statistics Yearbook from 2009 to 2018. Four categories and ten indicators of health resources were analyzed. A descriptive analysis was used to present the overall condition. The Health Resource Density Index was applied to showcase health-resource distribution in demographic and geographic dimensions. The global and local Moran’s I were used to assess the spatial autocorrelation of health resources. Concentration Index (CI) was used to quantify the equity of health-resource distribution. A Geo-Detector model and Geographic Weighted Regression (GWR) were applied to assess the association between gross domestic product (GDP) per capita and health resources.ResultsHealth resources have increased over the past ten years. The global and local Moran’s I suggested spatial aggregation in the distribution of health resources. Hospital beds were concentrated in wealthier areas, but this inequity decreased yearly (from CI=0.0587 in 2009 to CI=0.0021 in 2018). Primary medical and health institutions (PMHI) and their beds were concentrated in poorer areas (CI remained negative). Healthcare employees were concentrated in wealthier areas (CI remained positive). In 2017, the q-statistics indicated that the explanatory power of GDP per capita to beds, health personnel, and health expenditure was 40.7%, 50.3%, and 42.5%, respectively. The coefficients of GWR remained positive with statistical significance, indicating the positive association between GDP per capita and health resources.ConclusionsFrom 2009 to 2018, the total amount of health resources in China has increased substantially. Spatial aggregation existed in the health-resources distribution. Health resources tended to be concentrated in wealthier areas. When allocating health resources, the governments should take economic factors into account.
Highlights
China launched a new round of healthcare-system reform in 2009 and proposed the goal of equal and guaranteed essential medical and health services for all by 2020
In addition to the above ten indicators, we introduced the calculation of Beds per 1,000 people, healthcare employees (HCE) per 1,000 people, government health expenditure (GHE) Per Capital, the proportion of of-pocket payments (OOPs) in Total health expenditure (THE), and the proportion of THE in gross domestic product (GDP) for a overview of health resources
We introduced a GeoDetector model and Geographic Weighted Regression (GWR) to further measure the association between GDP per capita and health-resource distribution
Summary
China launched a new round of healthcare-system reform in 2009 and proposed the goal of equal and guaranteed essential medical and health services for all by 2020. In April 2009, China launched a new round of healthcare-system reform and set out to improve equitable access to medical services [12]. Since 2012, more emphasis has been placed on healthcare-delivery reform to increase health-service efficiency [10]. During this period, the government has issued a series of policies to promote equitable access to health resources, such as universal health insurance programs, zero-markup drug policy, patient-referral policy, medical alliance policy. The Healthy China 2030 program of the Chinese government that advocates to “accelerate the expansion of high-quality health resources and the balanced distribution of such resources among different regions” [13] has been regarded as a breakthrough for improving health [14]
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