| BackgroundHealth is a necessary requirement of promoting the people’s all-round development. Improving the health of the people and achieving perfect health systems are the ultimate directions and common pursuits of human society. Maintaining people’s health is not only a common responsibility of government but also becomes a global consensus. Universal health coverage is the subject of the 2013 World Health Report, which is to ensure that all people obtain the health services they need without risk of financial ruin or impoverishment, now and in the future. And health resources including inputs, health financing, infrastructure and information are fundamental elements for achieving universal health coverage.Since the establishment of P.R. China, its medical and health system has obtained remarkable achievements including the basic health service system coverage of both urban and rural area, further strengthened capacity of disease control, prevention and treatment, and the improvement of health indicators like life expectancy, infant mortality and maternal mortality came out top among the developing countries. Despite these achievements, there are still some problems of health resource in terms of the quantity, quality and allocation. The goal of building a moderately prosperous society by 2020 was proposed by the 18th National Congress of the Communist Party of China (CPC), and’Healthy China’ was officially presented as an important part of the 13th Five-Year Plan. Thus, health service system is under the new historical tasks. Among the whole system, health resources are the fundamental ones. How to allocate the resources and satisfy the diversified demand for health services become the key issue confronting every province.Shandong province, a province with prosperous economy and large population, has achieved a comprehensive advancement on health and family planning in parallel with the rapid economic development, and its health resources are at an advanced level all over the China. At the same time, Shandong is facing many health challenges amid its demographic and epidemiological transition of rapid economic growth, urbanization and industrialization, population ageing, diseases and risk factors related to lifestyle and environmental pollution. At present, Shandong province is at the period of the end of the’12th Five-Year Plan’, the beginning of’13th Five-Year Plan’and establishment of’Healthy Shandong’. All above situations put forward higher requirements on health resources allocation in Shandong province. In order to cope with the new trends, promote the health services development and deepen the health system reform, it has an important significance to study on the evaluation and projection of health resouces allocation in Shandong province.ObjectivesIn order to respond to new trends properly and provide references for the development of Shandong province’s long-term health and family planning, health resource allocation, regional health planning and policy formulation, it is necessary to have an in-depth current and retrospective analysis of health resource in Shandong province. And the strengths and weaknesses would be clarified. Thus, the main objectives of this study are focused on the following questions:Firstly, what are the status, trends and features of health resources allocation in Shandong province? Whether or not the economic and social development is coordinated with health resources? Secondly, how about the status and trends of residents’needs, demands and utilization of health service are? Thirdly, how about the status and trends of health resource allocation in terms of equity and efficiency in Shandong province are? Whether or not the goal of the plan and allocation could be achieved? Fourth, what is the projection of health resource in Shandong province in the next 5 to 10 years? Through the research and analysis of above issues, medium-long-term development of health policy implications of Shandong province would be put forward.MethodsData resources came from three aspects:Firstly, digital database including CNKI, Wan fang data library, PubMed, Web of Knowledge and so on, and the official website of different organizations like WHO, World Bank and governments. Secondly, official publications including’China Health Statistics Yearbook’, ’Shandong Province Statistics Yearbook’,’China Health and Family Planning Statistics Yearbook’,’Shandong Province Health and Family Planning Statistics Yearbook’and’China National Health Accounts Report 2014’. Thirdly, the fourth and fifth National Health Service Survey database of Shandong.The study methods mainly included descriptive analysis and statistical analysis. The descriptive analysis method was used on the context and trends parts. Gini index, CI and Thiel index were utilized on equity study. DEA analysis and related models were used on efficiency study. TOPSIS and Extenics theory were used on comprehensive evaluation of health resources allocation. The chapter of projection made use of application of health service need and demand method, health service objectives method and GM (1,1) models.Results1. The finance, population and health status:①At the end of 2014, the GDP ranked 3rd and per capita GDP ranked 10th in China. The health expenditure in the proportion of public finance budgetary had an increasing trend. But with the background of finance budgetary decreasing yearly and "New normal" trend, there is a heavy pressure on health expenditure growth. ②The number of population in Shandong, which was 5.85% larger than 2005, reached 97.89 million in 2014 and ranked 2nd in China. The population in Shandong in 2020 and 2025 would reach 101.1-102.2 million and 103.6-105.9 million respectively. From 2005 to 2014, the total dependency ratio, child dependency ratio and old aged dependency ratio rose a lot and the national family health survey showed that the 65+ elderly residents proportion of the urban and rural population was more than 15%. With the trend of population growth, aging situation wouldn’t be avoided by new population policy. ③The average life expectancy had increased from 75 years in 2005 to 78 years in 2014 and which was 3.5 years larger than the average level. The maternal mortality ratio declined from 22.13 per 100 000 live births in 2005 to 22.13 in 2014. The infant mortality rate dropped from 11.87 per 1000 live births in 2005 to 5.30 in 2014, and the under-5 mortality rate declined from 13.72 per 1000 live births in 2005 to 6.48 in 2014. And Shandong inhabitants’health status keep improving.2. Physical resources, human resources and health services utilization:① The number of health institutions had been increasing since 2005. In 2014, the total number of health institutions ranked 3rd, hospitals 1st and non-public medical institutions’amount increased from 2005 to 2014 with annual growth 21.14%. The total number of beds ranked 1st (beds per 1000 population 13th) and total assets of the health institutions ranked 3rd. During 2005-2014, the total health expenditure (THE) of Shandong increased a lot (ranked 2nd), while THE as a proportion of GDP increased and THE per capita ranked 17th. In 2013, government expenditure on health as proportion of total health expenditures was just 25.44%(ranked 26th).②By the end of 2014, the total number of health personnel ranked 1st (per 1000 population 6th). The total number of management staff and technicians ranked 5th. The total number of General practitioners (GPs) ranked 7th. And total number of GPs per 10000 population which ranked 21th was just 0.92, lower than even western areas. The number of licensed (assistant) physicians and registered nurses ranked 7th and 6th respectively. Based on the comprehensive evaluation on health resources, Shandong province ranked 10th in China. ③By the end of 2014, the number of outpatient visits to the health institutions were 632 million, while 1.3 times those in 2005(495 million). And the annual growth was 18.51% from 2005-2014. Per capita outpatient visits was 6.46 times. The number of treatments to the health institutions were 15 million, while 9.28 million more than 2005.3. Acccess to health services and health services need & demand of residents:①In the two surveys of 2008 and 2013, more than 80% households in both urban and rural areas were within a distance of 1km from the nearest health facility and could reach the nearest health facility in less than 10 minutes. ② Compared with twice surveys, the two-week morbidity rate among the surveyed residents increased obviously (rural areas were higher than urban areas, female than male). In 2013, the two-week morbidity rate of age group of 55+ was higher than 2008 significantly. And 80.1% of morbidity cases were chronic diseases cases lasting into two weeks.③In the survey areas, the two-week medical consultation rate was 80.9%, evidently higher than the 2008. During the two surveys,70% above residents went to primary health institutions including township hospitals, clinics and village health stations. Compared with 2008, hospitalization rate of all age groups and rural residents elevated rapidly in 2013.4. The evaluation of health resources allocation:①Health resources distribution in Shandong demonstrated equalities. Except for the geographic Gini coefficients of the licensed (assistant) physicians and registered nurses, the demographic and geographic Gini coefficients of all selected health indicators were lower than 0.2. And the geographic Gini coefficients of health facilities showed a downward trend. The equities of different regions were better than before and reached their peaks in 2014. What’s more, the gap of per capita health resources between urban and rural areas was eliminated.②In 2014, only Linyi, Dezhou and Heze’s CRS TE scores were 1 and the 3 cities accounted for 17.65% of 17 cities, left 14 cities lower than 1. There were 5 cities whose scores of VRS TE were 1 accounting for 29.4%.We observed that 4 cities were unchanged,5 cities on the increasing returns to scale portion of the VRS frontier and 8 cities on the decreasing returns. The reason of 14 inefficiency cities input excessively, especially asset of institutions with at least 25% more than efficiency. The average total factor productivity (TFP) of Shandong was less than 1 and 7 cities more than 1 from 2010 to 2014. In 2014,9 in 17 cities’TFP were more than 1. The cause of TFP improving was the improvement of EC. The unimproved cities were due to the unchanged or decline of EC and the decline of TC.③Under the current development level, the related goals of ’12th Five-Year Plan’ and ’Criteria of Health Resource Allocation’ of Shandong couldn’t be achieved.5. The projections of health resources:Based on the methods like health services need (demand), health services objective as well as GM (1,1) model and their comparisons, the method of health services need and GM (1,1) model were used to predict the health resources. The results were that licensed (assistant) physicians would reach 277.2-312.6 thousand in 2020 and 2025 respectively, registered nurses 346.5-390.8 and 382.1-508.6, and beds of institutions 455.3-743.4 thousand and 585-943.7 thousand. In addition, the growth rate of population will increase in next 5-10 years under the population policy changes. And the three kinds of health resources were 4.96%、11.69%、7.62% and 5.62%、 10.70%、7.98% respectively during the period of 2009-2014 and 2005-2014. Thus, the results of the study are conservative. So we regarded the upper limit of projected values in 2020 and 2025 as the targets.Conclusions and Policy Implications1. The total health resources and allocation level in Shandong province showed an increasing trend. And they were at the forefront position in China. The per capita resources had the same tren d and the health human resources better than the average of the East regions. Generally, health resources were among the forefront of the country and coordinated with the development of economy in Shandong. However, the indicators like the percentage of administrative and ground skilled staff and GPS number per ten thousand people were still backward. The two indicators lower than eastern and natiaonl average level respectively. The private expenditure on health as a proportion of THE remained high and government expenditure was low. In addition, THE as a proportion of GDP was too low to uncoordinated with the economy development.2. The accessibility of health services was better. The health resources for rural residents, women, elders and children should be taken into preferential consideration. The most threatening diseases of Shandong residents included circulatory system, respiratory and endocrine system and heart and brain vascular diseases. The ability of health services improved and attendance rate increased a lot. Primary medical institutions were regarded as the first choice for most residents. And inpatient demand of rural areas was much more than that of urban areas.3. The demographic and geographic distributions of health resources improved obviously and were quite equity, and the regional gaps dominated the general gap. The disparity between urban and rural areas was dropped off gradually and in terms of hospital beds were eliminated. The ratio between urban and rural areas turned to be 1. Health resources’inputs and outputs of CRS-TE and VRS TE had no more than 5 cities. Their health resources inputs were overplus. The decline trend of TFP was showed during the period of’12th Five-Year Plan’. And the restraint ability of Health Plan and Health Resources Allocation was too weak to guide the allocation and a few of goals didn’t be achieved.4. Based on the results, the need for health resources including doctors, nurses and beds would be huge. The increasing rate should be stable in the next period. We indicated that three health resources should keep 5%,7%-8% and 6%-7% average annual growth rate respectively. It’s necessary to make advanced plans and allocations.Based on the conclusions above, the implications were put forward on the following aspects:firstly, government spending on health sector should be increased and the efficiency of health resources usage should be promoted. Secondly, the pertinence of health resource allocation should be strengthened to deal with the situations and challenges. Thirdly, regional health resources allocation should be harmonious and the supervision & assessment ablility should be reinforced. Fourth, health human resource allocation should be optimized and the resource shortage should be eliminated. |
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