Study On The Equity Of Health Resources Allocation In Shanxi Province

Objective:Based on the analysis of the basic situation and equity difference of health resource allocation in Shanxi Province from 2014 to 2018,the allocation of health resources in recent five years in Shanxi Province,including medical institutions,beds,health technicians,licensed(Assistant)doctors,registered nurses,was analyzed from different perspectives by using Lorenz curve,Gini coefficient,Theil index,difference index,health resource concentration and other indicators Analysis,mutual verification,to explore the status quo of health resource equity in Shanxi Province,the trend in the past five years,the equity of health resource agglomeration in various cities,the difference of resource allocation according to the geographical and population distribution and the reasons for the distribution differences,in order to provide theoretical basis and decision-making reference for the formulation of relevant health policies or measures.Methods:Literature research method: focusing on the research topic,consult relevant literature,collect the research background,allocation status and equity analysis methods of health resources at home and abroad,and sort out,study and analyze the literature.Descriptive research method: describing the current situation of population,geography,social economy and development of Shanxi Province,as well as the descriptive analysis of the allocation of human,material and financial resources and the development trend of Shanxi Province.By using the methods of Lorenz curve,Gini coefficient,Theil index,index of dissimilarity and Health Resource Agglomeration Degree,this paper analyzes the equity of health resource allocation in Shanxi Province from different perspectives,including the differences in population and geographical distribution of health resources,the differences between and within regions in the north,middle and south of Shanxi Province,the equity of health resources and human resources,and the health resources in different cities Source concentration.Results:(1)health resource allocation in Shanxi Province Health human resources: The overall number of Shanxi's health human resources in 2014-2018 has shown an increasing trend.In 2018,compared with 2014,the total number of various health personnel was 28,449,an increase of 43,857,an increase of 17.86%.Health technical personnel Among them,the number of licensed(assistant)physicians,registered nurses,pharmacists,and technicians increased by 8,287,24,692,661,and 1,429,respectively.The medical care ratio in Shanxi Province in 2018 was 1: 1.10,lower than the national level.Compared with 2014,the number of health technicians per 1,000 population increased from 5.74 to 6.47,the number of practicing(assistant)physicians per 1,000 population increased from 2.46 to 2.54,and the number of registered nurses per 1,000 population increased from 2.17 to 2.78.Both are lower than the national level during the same period.Among the 11 cities,the largest number of health technicians per 1,000 population is 13.75 in Taiyuan City,the least is 4.09 in Shuozhou City,and the most practicing(assistant)physicians per 1,000 population is 5.10 in Taiyuan City,and the least is 1.69 in Shuozhou,the largest number of registered nurses per thousand population is Taiyuan,which is 6.66,and the least is 1.50 in Shuozhou.Health material resources: Shanxi Province's number of health institutions,number of beds,and number of beds per thousand population in 2014-2018 are increasing year by year.The number of health facilities increased from 12,528 in 2014 to 13,740 in 2018,and the number of beds increased from 177,442 The number increased to 208,298,and the number of beds per thousand population increased from 4.86 to 5.60,which was lower than the national level in the same period.In 2018,the number of hospitals increased to 1,368,and the number of community health service centers increased to 965.The number of hospitals decreased year by year,and in 2018 it was reduced to 1,609.The total number of health institutions in various cities in Taiyuan is 2748 at the most,Shuozhou is at least 567,the number of health institutions per thousand population is the most in Taiyuan 0.62,the least is in Changzhi 0.27,the most per square kilometer is 0.39 in Taiyuan City,0.04 in Xinzhou City.The maximum number of beds in Taiyuan is 39917,Yangquan is at least 7473,Taiyuan has the most 9.03 sheets,Lvliang 3.54 sheets,Taiyuan 5.74 sheets per square kilometer and Xinzhou 0.53 sheets at least.Health financial resources:from 2013 to 2017,Shanxi Province total health expenditures,government,society,personal health expenditures,total health expenditures as a percentage of GDP,total health expenditures per capita are rising year by year,2017 Shanxi total health expenditures were 108.774 billion yuan,An increase of 48.44% over 2013,the total health expenditure as a percentage of GDP was 7.01%,0.65% higher than the national level over the same period,the total health expenditure per capita was 2,932.24 yuan,lower than the national level of 3,784.83 yuan,the total health expenditure composition,Shanxi 's government health expenditure accounts for 29.99%,slightly higher than the national level,social health expenditure accounts for 37.92%,which is lower than the national level,and personal health expenditure accounts for 32.09%,which is higher than the national level.(2)Equity analysis of health resources in Shanxi Province Fairness analysis of Lorentz curve: in 2018,compared with 2014,the Lorentz curve of health resources by population and geographical distribution in Shanxi Province decreased to a certain extent,closer to the diagonal Line,and the degree of population and geographical fairness of health resources improved.In 2014 and 2018,five health resources in Shanxi Province: health institutions,number of beds,health technicians,licensed(Assistant)doctors and registered nurses,the overall curvature of Lorentz curve based on population distribution was less than the overall curvature based on geographical distribution,closer to the diagonal,and the fairness of health resources based on population distribution was better than that based on geographical distribution.Based on the fairness analysis of Gini coefficient: according to the population distribution,the Gini coefficient of health institutions,number of beds,health technicians and practicing(Assistant)doctors in Shanxi Province over the years is less than 0.2 except that the Gini coefficient of practicing(Assistant)doctors in 2017 is 0.2004.According to the standard of Gini coefficient,the Gini coefficient of registered nurses over the years is in an absolute fair state Between 0.2-0.3,it is in a relatively fair state.The Gini coefficient of the number of beds over the years is the smallest and the fairness is the best.The Gini coefficient of the registered nurses over the years is the highest and the fairness is the worst.The Gini coefficient of the health technicians is on the rise.According to the geographical distribution,the Gini coefficient of health institutions,number of beds,health technicians and practicing(Assistant)doctors in 2014-2018 is 0.3-0.4,which is relatively reasonable.The Gini coefficient of registered nurses over the years is 0.4-0.5,which exceeds the warning state of 0.4,which is in an unfair state with a large gap.In recent years,the Gini coefficient of health institutions is the smallest,and The Gini coefficient of nurses is the highest over the years.Fairness analysis based on the Theil index: the total Theil index of the number of beds over the years is the smallest,the fairness is the best,the total Theil index of registered nurses over the years is the largest,the fairness is the worst.The intra-regional Theil index of various types of health resources in the past is larger than the inter-regional Theil index,which shows that the intra-regional allocation difference of health resources in Shanxi Province is larger than the inter-regional allocation difference,and the intra-regional difference is the main reason for the unfair allocation of health resources in Shanxi Province.The Theil index of all kinds of health resources in Jinzhong Area is higher than that in the north and south of Shanxi Province,The Fairness of health resources allocation is the worst.The Theil index of health technicians and registered nurses in Jinzhong Area is larger,which shows that the Fairness of health technicians and registered nurses in Jinzhong Area is the worst.Fairness analysis based on the index of dissimilarity: the fairness of health material resources allocation according to population is better than that of health human resources.Among them,the index of dissimilarity of registered nurses by population in the past years is more than 0.17,which is much larger than the index of dissimilarity of other health resources,The fairness of the population distribution is the worst;the fairness of health material resources allocation according to geography is also better than that of health human resources,the geographical distribution of registered nurses has a historical index of dissimilarity of more than 0.28,which is much larger than that of other health resources,The fairness of the geographical distribution of registered nurses is also the worst.Fairness analysis based on agglomeration degree: Taiyuan,Datong,Yangquan and Yuncheng have the best agglomeration degree of health resources according to the geographical distribution,Shuozhou,Xinzhou and Luliang have the worst agglomeration degree according to the geographical distribution,and they are relatively scarce according to the geographical distribution.Among them,Taiyuan's agglomeration degree of health resources is too high,Xinzhou's agglomeration degree is too low,and the difference is wide.Taiyuan,the provincial capital,is located in Jinzhong region In terms of total amount,the health resources in Jinzhong Area are relatively surplus,while in the north area,the resources are relatively scarce,especially the health human resources.Conclusion:The total amount of health resources in Shanxi Province is rising,but it is lower than the national level.The population equity of all health resources is better than the geographical equity,and the geographical equity of registered nurses is the worst.The intra-regional difference of health resources was greater than the inter-regional difference,and the intra-regional difference was the main reason for the unfair allocation of health resources.The population equity and geographical equity of health material resources are better than that of health human resources.The health resources of taiyuan,the provincial capital city,are relatively surplus,and the health resources of xizhou,shuozhou,lvliang and other places are relatively lacking,with a large difference.