The Study Of The Allocation Equity Of Urban Community Health Service Resource In China

Objective:Based on theory of the allocation of health resources, health equity theory,regional heath planning and new public service theory, carried out an empirical studyon health service resources in urban community on J Province. Made itscountermeasures to improve the equity of health service resource in urban community,provided the theory reference and the basis for health management department, inorder to strengthen the equity and reasonability and provided reference basis for theoptimization of health resources allocation in urban community.Methods:Utilized the descriptive analysis and quantitative analysis to analyze2010~2013health statistics yearbook data in J province to understand the quantity and structure ofhuman resources, material resources and financial resources allocation of communityhealth resources allocation in urban. Utilized gini coefficient, theil index and concentrationindex to evaluate the equity of community health resources allocation and its factos. Topsisand RSR are combined to evaluate the reasonability of health resources allocation that152community health services center within the scope of J province.Results:1．The result of descriptive analysis from human resources showed that the totalnumber of health workers were5609~7836in2010~2013in J province urbancommunity health service centers, the total number of health technicians incommunity health service centers in urban of J Province. The number of healthtechnicians per thousand populations were0.74~0.99, the number of physicians perthousand populations were0.33~0.51. The number of registered nurses per thousandpopulations were0.29~0.36. In the year of2013,the number of health technicians,physicians and registered nurses in community health service centers in A region(which were economically developed areas) were highest in whole J province, the C region were lowest and the number of physicians and registered nurses were justonly0.25,0.23. Human resource in community health service centers over55years oldand less than25years old were8.27%and8.55%in2013in J province, young andmiddle-aged people were the main, distribution is featured on olive. The educationalbackground structure of technical secondary school,technical school and highschool’shuman resources in community health service centre occupies36.03%, juniorcollege occupies38.00%, bachelor degree occupies24.63%.2．The result of equity analysis of human resource showed that the highest ginicoefficient of human resources in urban community health service centers accordingto the population distribution were0.1806，and according to the geographicaldistribution were0.3177in2010~2013in J province. The total theil index of humanresources in urban community health service centers varies between0.0096~0.0284,the health technicians’s contribution rate of intra-regional theil index is greater thanthe inter-regional theil index besides2013. The concentration index of humanresources in urban community health service centers varies between-0.0372~0.0322.3．The result of descriptive analysis from material resources showed that the totalnumber of community health service centers were152~161in2010~2013in Jprovince, the number of beds were3206~5282that decreased year by year. Overall,the number of equipments were between3863~8654and came down every year. Thenumber of beds per thousand populations were between0.44~0.67, the number ofequipments per thousand populations were0.53~1.14. Community health servicecenters in C region had the lowest beds (0.30) and equipments (0.60) per thousandpopulations in2013, A region had the highest number of equipments per thousandpopulations and B region had the highest number of beds per thousand populations.4．The result of equity analysis of material resources showed that the ginicoefficient of urban community health service centers according to the populationdistribution were below0.15, according to the geographical distribution were below0.3in2010~2013in J province. The highest gini coefficient of beds in urbancommunity health services centers according to the population distribution were0.3593，according to the geographical distribution were0.3140. The highest ginicoefficient of equipments in urban community health services centers according to thepopulation distribution were below0.25，according to the geographical distribution were between0.3088-0.3689. The total theil index of urban community healthmaterial resources allocation varies between0.0064~0.1220, the communitiy healthservice centers numbers’ contribution rate of intra-regional theil index is lower thanthe inter-regional theil index besides2012. The concentration index of urbancommunity health material resources allocation varies between-0.2566~0.1522, theconcentration index of equipments were positive value, and increasing steadily, itwere0.1522in2013, the concentration index of centers and beds were negative value.5．The result of descriptive analysis from financial resources showed that theamounts of financial aid per thousand populations were39600~84100(yuan) CNY in2010~2013in J province, A region received the most financial support. Total fiscalrevenue of urban community health service centers were849.0459million(yuan)CNY in2013in J province, which accounted for57.72%of financial aids, medicalincome accounted for39.47%, the financial aids per thousand populations in A regionwere80000(yuan) CNY which were highest, the financial aids per thousandpopulations in C region were46800(yuan) CNY which were lowest. Outpatientmedical income of urban community health service centers accounted for79.86%.financial revenue and expenditure surplus were33.9646million(yuan) CNY, whichcommunity health service centers in A, B,C region financial surplus rate were0.25%、26.87%、6.45%.6．The result of equity analysis of human resource showed that the ginicoefficient of financial resources in urban community health service centers accordingto the population distribution were0.1247~0.3100，and according to the geographicaldistribution were0.3053~0.3991in2010~2013in J province. The total theil index offinancial resources in urban community health service centers varies between0.0261~0.0865, the contribution rate of intra-regional theil index is greater than theinter-regional theil index. The concentration index of financial resources in urbancommunity health service centers varies between0.0887~0.2022, all of them werepositive value.7．After ordering by Topsis and RSR method,152urban community healthservice centers in J province had the Civalue of0.3706~0.9323in2013, there were25(16.45%),104(68.42%),23(15.13%) community health service centers wereevaluated to be good, secondary and bad degree. Conclusion:1．The number human resources, material resources and financial resources inurban community health service centers in J province had reached the2006nationalrelevant standard basically, but there were regional differences. The main problems ofurban community health service resources allocation in J province were lower humanresources degree, shortage of health works in economically undeveloped region,rental housing existed and shortage of house area in some centers.2．The result of analysis based on the gini coefficient showed that the humanresources, material resources and financial resources in resources in urban communityhealth service centers in J province were equity condition overall, the equity of threekinds of resources according to the population distribution were better than accordingto the geographical distribution.3．The analysis result based on the theil index showed that the human resources,material resources and financial resources in resources in urban community health servicecenters in J province were equity condition overall, the equity of intra-regional had a greatlyeffect on human resources and financial resources, In material resources aspects, the equity ofinter-regional had a greatly effect on the number of community health service centers, theequity of intra-regional had a greatly effect on the number of beds and equipments4．Theresult of analysis based on concentration index showed that the human resources, materialresources and financial resources in resources in urban community health service centers in Jprovince were equity condition overall, the number of equipments and the amount offinancial aid were conducive to the inequity of rich person.5．The health resource allocation in urban community health service centers in Jprovince had greater difference. The health resource allocation in economicallydeveloped regions was better than economically undeveloped region, and theeconomic was the important factors of health resource allocation. There were inequities ofhealth resource allocation in urban community health service centers in same intra-regional,the number of registered nurses, equipments and beds were shortage, which led to the “bad”degree that urban community health resource evaluated.