Study On The Equity And Efficiency Of Primary Health Resources Allocation In Liuyang City

Objectives: To describe allocation and utilization of primary health resources in Liuyang City,to analyse the equity and efficiency of primary health resources allocation in Liuyang City,and to explore the influencing factors of allocation efficiency,so as to provide a scientific basis for optimising the allocation of local primary health resources.Methods: To collect comprehensive data on the allocation of health resources and the development of healthcare services in primary health care institutions in Liuyang City from 2015 to 2020.To analyze the equity of primary health resources allocation in Liuyang City by using Gini coefficient,Theil index and Health Resource Agglomeration Degree(HRAD).The DEA-CCR model,DEA-BCC model and DEA-Malmquist index model were used to analyze the static efficiency and dynamic efficiency of primary health resources allocation in Liuyang city,and the Tobit model was used to analyse the influencing factors of allocation efficiency.Results: 1.Resources allocation and utilization:(1)Overall,urban areas had higher health resources per 1,000 population and per square kilometer than rural areas.(2)The ratio of doctors to nurses had been fluctuating around 1:1 from 2015 to 2020.(3)In 2020,two-week prevalence among local residents was 13.7%;the proportion of two-week sickness visits was 80.4%;the highest proportion of visits was made to village health offices/ community health service stations/ clinics at 62.0%.(4)The average number of physician visits per day in urban areas was lower than in rural areas,while the average number of physician bed days,bed occupancy rate and the average length of stay for those discharged from hospital were higher than in rural areas.2.Results of the equity analysis:(1)In 2015-2020,the Gini coefficients of equipment worth more than 10,000 yuan,registered nurses and actual beds by population and by geographical distribution all exceeded the warning line of 0.4;and the Gini coefficients of full-time public health personnel and financial allocations by population and geographical distribution were all less than 0.4;the Gini coefficients of health workers,health technicians and practicing(assistant)physicians by population distribution did not exceed 0.4,the Gini coefficients by geographical distribution were all above the warning line.(2)The Theil index of each primary health resources within regions in 2015-2020 were all much larger than the Theil index between regions.(3)All HRAD of 7townships(streets)were greater than 1 including Huaichuan,Shegang,etc;All HRAD of 13 townships(streets)were less than 1 including Dahu,Zhangfang,etc.3.Results of the efficiency analysis:(1)In 2020,the average values of Technical Efficiency(TE),Pure Technical Efficiency(PTE)and Scale Efficiency(SE)of urban areas were higher than those of rural areas;the TE of townships(streets)such as Wenjiashi,Yongan was low.(2)In2020,the average value of the whole city’s PTE was higher than that of SE;there were 12 townships(streets)with SE of 1;there were 22townships(streets)with PTE of 1.(3)In 2015-2020,the index of TFPC for each annual period was less than 1;the average values of Technical Efficiency Change(TEC)index,Pure Technical Efficiency Changes(PTEC)index and Scale Efficiency Changes(SEC)index were all greater than 1;the Technological Change(TC)index was less than 1 in each annual period.(4)According to the Tobit regression results,the number of health personnel per 1,000 resident population,the amount of financial allocation per resident population,the proportion of health technicians,the proportion of full-time public health personnel,the average number of physician visits,and the proportion of financial allocation income to total income significantly influenced the allocation efficiency.Conclusions: 1.The allocation level of primary health resources in rural areas was significantly lower than urban areas in Liuyang City;the structure of primary health human resources was not reasonable enough,and the ratio of doctors to nurses was low.2.Equipment worth more than 10,000 yuan,registered nurses and actual beds were less equitable by population and by geography;full-time public health personnel and financial allocations were more equitable by population and by geography;health personnel,health technicians and practicing(assistant)physicians were more equitable by population,but less equitable by geography;intra-regional differences were the main factors affecting the equity of allocation;the allocation of primary health resources in each township(street)was not balanced enough,there was a high concentration of health resources in townships(streets)such as Huaichuan,Shegang,a low concentration of health resources in townships(streets)such as Zhangfang,Dahu.3.The allocation efficiency in rural areas was lower than that in urban areas;the allocation efficiency in townships(streets)such as Wenjiashi,Yongan were low;the impact of SE on TE was greater than the impact of PTE on TE;the TFP of the city’s primary health resources continued to decline from 2015 to 2020;the number of health personnel per 1,000 resident population,the amount of financial allocation per resident population,the proportion of health technicians,the proportion of full-time public health personnel,the average number of physician visits,the proportion of financial allocation income to total income were the main influencing factors of allocation efficiency.