Trends in health resource disparities in primary health care institutions in Liaoning Province in Northeast China

Shuping Wang,Jin Xu,Suhang Song,Xiaofeng Jiang,Erdan Huang,Qingyue Meng,Chaofan Li,Hongmin Li

doi:10.1186/s12939-018-0896-8

Abstract

BackgroundThe allocation of health resources in primary health care institutions (PHCI) is crucial to health reform. China has recently implemented many reform measures emphasizing the provision of primary health care services, with equity as one of the major goals. The aim of this study was to analyze the quantity, quality, and distribution of health resources in Liaoning Province from 2005 to 2017.MethodsData were drawn from the annual financial report from 2005 to 2017 and information from the Liaoning Province Department of Statistics. Numbers of beds and physicians were used as indicators of health resources. Capital assets per bed, value of medical equipment per bed, operational space per bed, and number of physicians with different educational levels were used as indicators of quality of health resources. Concentration indices (CI) and Gini coefficients were calculated.ResultsThere was a steady rise in health resources in PHCI. From 2005 to 2017, the quality of health resources improved. The CI of beds showed an overall downward trend, indicating an improvement in the disparity among PHCI. There was a similar trend in the CI of fixed assets per bed. The Gini coefficients of physicians overall and physicians with different educational levels were almost always < 0.3, showing preferred equity status. There was a decreasing trend in the Gini coefficients of PHCI physicians with bachelor’s degrees or higher and physicians with associate’s degrees. The proportion of health resource of PHCI in health system increased from 2005 to 2009, before decreasing from 2009 to 2017 and the percentage of physicians overall and physicians with bachelor’s degrees or higher in PHCI declined after 2011.ConclusionsThere was an improvement in the quantity and quality of health resources in PHCI from 2005 to 2017. The distribution of health resource allocation in PHCI also improved. The findings revealed that the measures for the improvement of PHCI physicians’ educational level has been successful and the measures taken by the government in health reform to strengthen the primary health care system have not been successful.

Highlights

The allocation of health resources in primary health care institutions (PHCI) is crucial to health reform
The Concentration indices (CI) is defined as twice the area between the concentration curve and the line of equality: C = 2cov(x,h)/μ, where x is the fractional rank in terms of gross domestic product (GDP) per capita, h is the indicator for health resources and services, and μ is the mean of the health indicator
The fixed assets of medical facilities represent the capital of the medical service system, and medical equipment and operational space constitute the basic environment for supplying health services

Summary

Introduction

The allocation of health resources in primary health care institutions (PHCI) is crucial to health reform. China has recently implemented many reform measures emphasizing the provision of primary health care services, with equity as one of the major goals. In China, the primary healthcare system provides generalist clinical care and basic public health services. Equity is one of the basic principles of the allocation of health resources, and it is the basis for achieving fairness in the provision of health services [4]. Evidence indicates that access to primary health care can play a crucial role in promoting regional health equity [5,6,7]. Research on the fairness of health resource allocation in primary health care is of great significance for the realization of equity in basic health services [9]

Objectives

Methods

Results

Discussion

Conclusion