With the aging of the population and the increase of the proportion of patients with chronic diseases, the people's demand for primary medical resources is diversified and complicated. There are differences in the demand for primary medical resources among different regions and different groups of people. Some areas are facing the problem of lack of primary medical resources, which seriously restricts the coverage and quality of primary medical and health services, and greatly affects the medical experience and health status of residents.
In order to promote the high-quality development of the primary medical and health service system, the health distance model is introduced to analyze the spatial and temporal evolution process of the allocation mismatch of primary medical resources in China from 2011 to 2021, so as to provide reference for rationally formulating regional health plans, optimizing the allocation of medical resources, improving the capacity of primary medical and health services, and promoting the high-quality development of medical and health services.
An evaluation index system for the mismatch of primary medical resources was established from the three levels of health material resources, human resources and security resources. Data were obtained from the China Statistical Yearbook and China Health Statistics Yearbook. The bi-level programming model and the health distance model were used to measure the mismatch of primary medical resources allocation from 2011 to 2021.
From 2011 to 2021, the overall mismatch degree of primary medical resources allocation in China has a significant downward trend, but the mismatch degree differences between regions and provinces continue to expand. The average values of mismatch in the eastern, central and western regions in 2011 were 0.633, 0.624 and 0.754, respectively, which were moderate mismatch, mild mismatch and severe mismatch. In 2021, the average values of mismatch in the eastern, central and western regions are 0.479, 0.522 and 0.639, respectively, which were moderate matching, mild matching and moderate mismatch.
Promoting the expansion of high-quality medical resources and promoting the balanced layout of regional medical resources are the premise of building a high-quality and efficient medical and health service system. In order to further optimize the allocation of primary medical resources and improve China's medical and health service system, we should formulate reasonable macro policies in combination with the characteristics of each region, improve the level of economic development, optimize the structure of fiscal expenditure, improve the administrative capacity of local governments, reduce the mismatch of primary medical resources allocation, and realize the high-quality development of primary medical and health service system.
China entered an aging society in 1999, characterized by rapid growth rate, large population base, and the distinctive pattern of "aging before affluence". The intensifying aging trend poses significant challenges to the pension system, making the implementation of elderly health management a scientifically sound response strategy. As gatekeepers of primary healthcare, general practitioners play a pivotal role in advancing elderly health management and implementing the "comprehensive health management" philosophy, serving as the primary force in addressing aging-related challenges.
This study investigated the dynamic geographical distribution and equity disparities in the allocation of geriatric general practitioner human resources across China from 2012 to 2021, while analyzing the influencing factors of human resource allocation levels. The findings aim to provide evidence-based references for policymakers to formulate scientific human resource allocation strategies for elderly healthcare services.
This study collected relevant data from the China Statistical Yearbook and China Health Statistics Yearbook spanning 2013 to 2022. By calculating the changing trends of Gini coefficients and Theil indices based on the total and elderly population distributions, we assessed the equity in human resource allocation of geriatric general practitioners. Furthermore, a two-way fixed effects panel model was constructed to examine the province-level allocation of general practice human resources across various regions.
During the period from 2012 to 2021, the total number of general practitioners in China increased by 325 074, with all provinces demonstrating varying degrees of growth in their general practitioner workforce. The number of general practitioners per 10 000 elderly population reached 21.66, while the Gini coefficient decreased from 0.38 to 0.33. Both the overall Theil index and its inter-group and intra-group components exhibited declining trends. The results of the panel two-way fixed effects model analysis revealed that among healthcare resources: the number of nurses exerted a significant negative effect, whereas bed capacity and licensed physicians demonstrated significant positive effects on resource allocation. Population size and aging rate showed positive associations with resource distribution. Road density exhibited a negative impact on resource allocation. However, economic development level, educational indicators, and outpatient service volume did not exhibit statistically significant effects.
From 2012 to 2021, China witnessed sustained development in the allocation of human resources for geriatric general practitioners, accompanied by progressive improvements in equity. Given this trend, policymakers should holistically consider multiple factors—including population aging rates—when formulating workforce allocation strategies for general practitioners, to achieve more scientifically grounded and rational resource distribution.
General practitioners, as the gatekeepers of resident health, are the main force in China's grassroots medical and health services. The prominent problems of shortage of grassroots talent resources and unreasonable talent structure in Xinjiang Uygur (Xinjiang) urgently need to be solved.
On the basis of understanding the current situation of the allocation of general practitioners in Xinjiang, to evaluate the fairness of allocation and predict the number of general practitioners in demand and gaps in the autonomous region from 2025 to 2030, so as to provide a reference for the rational allocation and training of general practitioners in the region.
Data on general practitioners in Xinjiang from 2012 to 2019 was collected, with sources including the China Statistical Yearbook (2021), the China Health Statistics Yearbook (2013-2020), and documents from the Health Commission of the Xinjiang Uygur Autonomous Region. The allocation fairness of general practitioners was analysed using the concentration index, lorenz curve, and gini coefficient. Additionally, the average growth model and health demand forecasting method were utilised to predict the required number of general practitioners and the corresponding shortfall.
The average annual growth rate of general practitioners in Xinjiang was 16.58%. It is predicted that by 2025, 9 411-9 452 general practitioners will be needed, with a gap of 3 938-3 979; the agglomeration degrees of area allocation were all less than 1, and the agglomeration degrees of both were declining year by year; the number of general practitioner training places in each region and the overall Gini coefficient were less than 0.300, and the overall and northern Xinjiang regions were all allocated according to geographical area. The Gini coefficients were 0.415 and 0.457, and the Gini coefficients of other regions were all less than 0.300.
The allocation and training of general practitioners in Xinjiang has made some progress, the growth rate is fast, and the number has reached the overall goal, but there is still a big gap. The fairness of general practitioner resources allocation based on population is better than allocation based on geography. It is the main source of unfair allocation of training places according to geographical area. Therefore, in the further allocation and training of general practitioners, it is necessary to continue to strengthen the team of general practitioners on the basis of reference to the forecasted demand and gap, and to continuously improve the fairness of allocation based on geographic area with key areas as the starting point. While ensuring the number of general practitioners, the accessibility of health services should be taken into account.
