中国全科医学 ›› 2023, Vol. 26 ›› Issue (19): 2339-2345.DOI: 10.12114/j.issn.1007-9572.2022.0686

所属专题: 健康公平性最新文章合集

• 论著·基层卫生服务研究 • 上一篇    下一篇

中国全科医生资源配置公平性现状研究

寇儒欣1, 梅康妮1, 秘玉清1, 陈彤1, 邓神根1, 邢家润1, 王芊芊2, 王梦雪2, 李伟1,*()   

  1. 1.261021 山东省潍坊市,潍坊医学院公共卫生学院
    2.261021 山东省潍坊市,潍坊医学院管理学院
  • 收稿日期:2022-09-23 修回日期:2023-03-10 出版日期:2023-07-05 发布日期:2023-04-13
  • 通讯作者: 李伟

  • 作者贡献:寇儒欣、梅康妮负责文章初稿的撰写与数据处理;秘玉清负责对文章进行审查,并提出修改意见;陈彤、邓神根负责相关文献的收集与理论分析;邢家润、王芊芊、王梦雪负责原始数据的查找与整理;李伟对文章的结构逻辑、可行性进行指导、审查,负责文章的质量控制与审校,对文章整体负责。
  • 基金资助:
    国家自然科学基金资助项目(71774119); 全国统计科学研究项目(2021LY033); 中国学位与研究生教育学会研究课题(2020MSA247); 山东省人文社会科学课题(2022-ZXJK-18)

Fairness in the Distribution of General Practitioner Resources in Chinese Mainland

KOU Ruxin1, MEI Kangni1, BI Yuqing1, CHEN Tong1, DENG Shengen1, XING Jiarun1, WANG Qianqian2, WANG Mengxue2, LI Wei1,*()   

  1. 1. School of Public Health, Weifang Medical University, Weifang 261021, China
    2. School of Management, Weifang Medical University, Weifang 261021, China
  • Received:2022-09-23 Revised:2023-03-10 Published:2023-07-05 Online:2023-04-13
  • Contact: LI Wei

摘要: 背景 近年来国家高度重视全科医生队伍建设和基层卫生服务体系建设工作。围绕创新全科医生培养与使用激励机制和健全全科医生培养体系,政府出台了许多政策,从多个方面提出了多项重大改革举措。 目的 分析和评价中国全科医生资源配置公平性,为科学、公平分配全科医生资源提供理论支持。 方法 于2022年6月,以2017—2021年《中国卫生和计划生育统计年鉴》《中国卫生健康统计年鉴》和《中国统计年鉴》作为数据源,提取2016—2020年全国、各省份、各地区(东、中、西部地区)的全科医生数、注册为全科医学专业的人数、取得全科医生培训合格证的人数、每万人口全科医生数、执业(助理)医师数,以及2016—2020年国内生产总值、地区生产总值、各省份年末总人口数据;从中国政府网的国情栏目中提取各省份土地总面积数据。使用洛伦兹曲线与基尼系数分析中国全科医生资源配置公平性,使用泰尔指数分析我国东、中、西部地区全科医生资源配置差异性。 结果 中国全科医生数由2016年的209 083人增长到2020年的408 820人,2020年中国全科医生数较2016年增长了95.53%。2020年,在执业(助理)医师中,全科医生占比已达10.01%(408 820/4 085 689),每万人口全科医生数为2.90人。2016—2020年中国全科医生资源配置在人口维度上的基尼系数分别为0.235、0.231、0.225、0.177、0.157,在经济维度上的基尼系数分别为0.178、0.170、0.161、0.147、0.136,在地理维度上的基尼系数分别为0.722、0.726、0.729、0.714、0.707;相较于地理维度的洛伦兹曲线弯曲程度,人口维度与经济维度的洛伦兹曲线弯曲程度更小。人口维度的泰尔指数由2016年的0.046降至2020年的0.020,经济维度的泰尔指数由2016年的0.022降至2020年的0.013,地理维度的泰尔指数由2016年的0.482降至2020年的0.428。 结论 近5年来,中国全科医生数量快速上升,全科医生已成为执业(助理)医师队伍的重要组成部分,全科医生注册率也在逐渐升高,全科医生资源总量持续增长,但每万人口全科医生配比依旧不理想,不同区域之间的全科医生资源配置还存在很大差异,地理维度的全科医生资源配置公平性与人口、经济维度的全科医生资源配置公平性相比水平较差。

关键词: 全科医生, 资源配置, 洛伦兹曲线, 基尼系数, 泰尔指数, 健康公平

Abstract:

Background

In recent years, China has attached great importance to strengthening the development of general practitioner (GP) workforce and primary care service system. To innovate the incentive mechanism for GP training and employment and improve the training system for GPs, the government has also promulgated a series of policies and put forward major reform measures involving many aspects.

Objective

To analyze and evaluate the fairness of distribution of general practitioner (GP) resources in China, and to provide theoretical support for scientific and equitable allocation of GP resources.

Methods

Data were sourced from five volumes of China Health and Family Planning Statistical Yearbook (2017—2021), China Health Statistical Yearbook (2017—2021), and China Statistical Yearbook (2017—2021) in June 2022, including the number of GPs, the number of people registered as general medicine professionals, the number of people who obtained the General Practitioner Certificate after training, the number of GPs per 10 000 population, and the number of practicing (assistant) physicians in China, in each geographical division (eastern, central or western), and in each regionin, and the annual gross domestic product (GDP), gross regional product (GRP), and the year-end total population data of each region during 2016 and 2020. Additionally, the total land area of each region was extracted from the China ABC column on the website www.gov.cn. The Lorenz curve and the Gini coefficient were used to analyze the fairness in the distribution of GP resources. The Theil index was used to analyze differences in the distribution of GP resources in eastern, central and western China.

Results

The number of GPs in China increased from 209 083 in 2016 to 408 820 in 2020, showing a growth rate 95.53%. In 2020, the proportion of GPs among all practicing (assistant) physicians reached 10.01% (408 820/4 085 689), and the number of GPs per 10 000 population was 2.90. The Gini coefficients measuring demographic, economic, and geographical distribution inequalities of GP resources were 0.235, 0.178, 0.722, respectively for 2016, 0.231, 0.170 and 0.726, respectively for 2017, 0.225, 0.161 and 0.729, respectively for 2018, 0.177, 0.147 and 0.714, respectively for 2019, and 0.157, 0.136, and 0.707, respectively, for 2020. Overall, the Lorenz curve measuring the inequality in the distribution of GP resources by demographics or economy had lower degree of curvature than that by geography. A reduction was found in Theil index measuring unequal demographic, economic or geographical distribution of GP resources in 2020 compared with that in 2016 (from 0.046 to 0.020; from 0.022 to 0.013; from 0.482 to 0.428) .

Conclusion

During the five years, the distribution of GP resources in China presented the following features: the number of GPs increased rapidly and became an important part of the workforce of practicing (assistant) physicians, the registration rate of GPs gradually increased, and the total GP resources showed a continuous growth, but the ratio of GPs per 10 000 population was still unsatisfactory, great inter-region differences existed in the distribution of GP resources, and the equity of the distribution of GP resources by geography was more unsatisfactory than by demographics or economy.

Key words: General practitioners, Distribution of resources, Lorenz curve, Gini coefficient, Thiel index, Health equity