| ObjectiveA comprehensive and systematic evaluation was made on the allocation of health resources at county level in Guangxi during the “13th Five-Year Plan”period,so as to provide evidence-based basis for the formulation of policies and measures for the development and reform of medical and health undertakings at county level in Guangxi during the “14th Five-Year Plan” period.Method1.Rothwell and Zegvold’s three types of policy text analysis tools,namely supply,demand and environment,were used to analyze the health policy documents related to health resource allocation released at the national level since the new medical reform in China.2.Based on the relevant data such as the number of medical and health institutions,beds,health personnel,licensed(assistant)doctors,registered nurses in Guangxi during 2015 to 2020 from the national and Guangxi statistical Yearbook,health statistical Yearbook as well as the Health Statistics Information Center of Guangxi Zhuang Autonomous Region,descriptive statistical analysis was used to analyze the allocation of health resources at county level and the differences among different regions in Guangxi from 2015 to 2020.3.Lorentz curve and Gini coefficient were used to analyze the equity of health resources in guangxi health counties in terms of population,geography and economy from 2015 to 2020.Theil index was used to analyze the contribution rate of inter-regional and intra-regional differences to the overall population,so as to analyze the reasons leading to the unfair allocation of health resources in counties.4.DEA and Malmuquist index were used to evaluate the allocation of health resources at county level in Guangxi from dynamic and static efficiency.RSR analysis was used to classify and rank the allocation efficiency of health resources at county level in Guangxi.Spatial distribution and influencing factors of health resource allocation efficiency at county level in Guangxi were also analyzed from the perspective of spatial metrology,in order to find out the spatial influencing factors of health resource allocation efficiency at county level.Results1.Policy text analysisIn the policies related to the allocation of health resources formulated by the state,the use of basic policy tools is both excessive and insufficient.Among them,environmental tools account for 53.52%,exceeding the total proportion of supply and demand,and the application is excessive;Supply tools took the second place,accounting for 26.29%;Demand tools account for only 20.19%.The uneven distribution of secondary items of various types of tools is prominent.Supply tools mainly focus on training and assistance,and the application frequency of other items is low,with the least capital investment.From the perspective of various policy tools,patients are less involved in supply-oriented policy tools,and government and medical personnel are less involved in demand-oriented policy tools.2.Allocation of health resources at county level in Guangxi from 2015 to20202.1 Medical and health institution configuration.The number of hospitals in Xi County increased from 248 in 2015 to 356 in 2020,an increase of 42.75%;The average annual growth rate was 7.5%.Among them,the average annual growth rate and increase rate of specialized hospitals are the largest.Primary health care institutions are on the decline;The number of CENTERS for Disease Control and Prevention and health surveillance remains the same.2.2 Bed allocation in various medical and health institutions.The total number of beds in medical and health institutions increased by 37.39%,with an average annual growth rate of 6.56%.Among them,the number of hospital beds had the highest growth rate(49.82%)and the highest annual growth rate(8.42%).In terms of the proportion of beds in various medical and health institutions,the number of beds in hospitals accounted for the largest proportion,which was over 50%,followed by primary medical and health institutions,which accounted for about 40%.2.3 Allocation of health workforce.The number of health workers,health technicians,practicing(assistant)doctors and registered nurses in county increased,while the number of rural doctors and health workers showed a negative trend.The educational background of county health technicians in Guangxi is relatively low,especially the educational background of practicing(assistant)physicians and registered nurses in township hospitals are mainly technical secondary school and technical secondary school,accounting for about50%.The proportion of master degree and above is the lowest.2.4 Allocation of health resources per capita.The number of health technicians per 1,000 county residents increased from 3.79 in 2015 to 6.5 in2020,a year-on-year increase but still lower than the average level of Guangxi.Number of practicing(assistant)doctors with general practitioner training certificates per 10,000 population in the county was 2.7,higher than the average level of Guangxi.3.Equity of health resources allocation at county level in GuangxiFrom 2015 to 2020,from the geographical dimension,the Gini coefficient of beds in general hospitals,TCM hospitals and township health centers was less than 0.4,indicating relatively poor fairness.The Gini coefficient and Theil index of TCM doctors,rural doctors and health workers showed an increasing trend year by year,and the Gini coefficient of TCM doctors exceeded the warning line of 0.4 in 2020,showing a relatively unfair state.The analysis results of Theil index show that the main reason for inequity is the differences among different geographical regions and three economic zones.4.Health resource allocation efficiency and its influencing factorsIn 2020,the average comprehensive efficiency,pure technical efficiency and scale efficiency of health resources allocation in 14 prefecture-level cities and counties in Guangxi were 0.998,1.000 and 0.998,respectively.In 2020,except Baise city,the health resources of other prefecture-level cities and counties showed effective DEA,accounting for 92.86%.The prefecture-level cities of Baise are weak in DEA efficiency and decreasing in return to scale,accounting for 7.14%.From 2015 to 2020,total factor productivity averaged0.882.Three counties,nanning,Guilin and Yulin,are rated as "good",all of which are economically developed counties in Guangxi.Nine were rated as "medium";Two were rated as "poor" : Fangchenggang and Hezhou.Health resource allocation efficiency at county level has spatial autocorrelation.There was a positive correlation between the urbanization rate and the number of medical visits and the efficiency of health resource allocation,and the regression coefficients were statistically significant(P < 0.05).Conclusion1.The policy distribution of optimizing health resource allocation is unbalanced,and the interests and demands of stakeholders need to be balanced.Policies involving medical and health institutions and government departments account for a large proportion,while those involving medical staff and patients account for a small proportion,which easily leads to the disharmony of interests among stakeholders.Therefore,the top-level design of policy should start from the overall perspective and play the leading and leading role of policy from the macro perspective.2.The per capita ownership of county health human resources is insufficient,and the structure needs to be optimized.The total amount of county health resources is increasing year by year,but the number of health technicians per 1000 people in Guangxi county is lower than the average level of Guangxi.The structure of county health talents is not reasonable,there is a serious shortage of high-level talents,and the education and professional titles of health technicians are low.The shortage of health human resources in the county is still serious,which has a prominent contradiction with the urgent development of grass-roots medical and health care.Therefore,the relevant mechanism should be perfected to optimize the allocation of health human resources in county area.3.Regional economic development affects the equity of health resource allocation.The balanced development of regional economy is the basic requirement of the equitable distribution of health resources among regions.In the future,it is suggested to promote the construction of county public health institutions and promote the sharing of high-quality health resources.4.County health resources allocation efficiency is affected by complex social structure and urbanization rate.There are differences in social and economic development and social structure among counties in Guangxi,and the disequilibrium phenomenon of health resources allocation in counties will exist for a long time,which is affected by many factors such as politics,economy and culture.For the less developed areas in Guangxi,the urbanization rate is conducive to optimizing the efficiency of health resource allocation to a certain extent,and can promote regional development,so as to attract more health human resources and improve the efficiency of health resource allocation through health human capital.Improving the internal fine management system and mechanism of medical and health institutions can effectively improve the efficiency of hospital operation.5.During the 13 th Five Year Plan period,the balance of county health resources allocation in ethnic minorities and border areas was poor.The majority ethnic minorities live in remote and poor mountainous areas.Due to backward economic development,inconvenient transportation and other factors,it is difficult to attract and retain health talents.As a result,the possession of health resources per 1000 population and per square kilometer in Guangxi ethnic minority areas and border areas is lower than the average level of the whole region,and most lack of health human resources.It is suggested that a long-term mechanism should be gradually established for the development of health undertakings at county level in guangxi ethnic minorities and border areas. |
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