| Rational distribution of physician resources is the key issue of meeting the people's demands for the basic medical services in China.One of the most important aspects of the rational allocation of physician resources is to analyze the equity of the distribution and its influencing factors.From the prospective of economics,this paper summarized the main methods to predict and major measures to control physician resources at home and abroad.Also,Gini coefficient,Theil index,Geographic Information System(GIS)and Panel Data Model were used to evaluate the unfairness of physician resources distribution and its determinants in Shanghai,and to solve the following questions step by step,Wwhy physician resources should be distributed equitably?What are the specific requirements??what about the current situation of the equity of physician resources distribution in Shanghai?? what are the influencing factors of the equity of physician resources distribution,how many are positive?how many are negative?? how to make the related policies and institutional arrangements to develop the extent of equity?This paper figured out the inherent rules of physician distributions and the policy roots of current situations,used methods of combined theory with practice,and combined of qualitative-quantitative,aiming at providing scientific suggestions on promoting the extent of equity of regional physician resources distributionThe paper was divided into introduction and six chapters.The introduction discussed the background and significance,aim and content,methods and technical route of the study,the new ideas and data resources of the research,and etc.Chapter 1 sorted out the main economic theories related to this research.Specifically,this mainly involved the following four aspects:The first was the theory of human capital and human resources.In this part,the characteristics of human capital,and the intrinsic and logical relationships between human resources and human capitals were analyzed.From the macroscopic and microscopic aspects of the related factors on physician staffing,it figured that physician resources had some similar characteristics with human capital,such as considerable input costs,adjustability,motivation,individual differences in values,variability and etc,.The second was the theory of health economics.Comparing with the general commodity market,the medical sector had it own characteristics.Therefore,it was important to clarify the role of the government and market itself in health resources distribution,especially the main function of the government in health sector.It also figured that physician resources,as parts of health resources,should own a certain degree of equality,and required government interferences to make up for the failure of price mechanism,which was caused by the externality or the direct effect of incentives from conduced needs on medical service performance.The third was the theory of institutional economics.Based on the history of medical health system,also combined with the theory of institutional economics,this part found that the interference would be effective only when the system met the needs of economic and social development,had potential benefits and the incentive structure was helpful to improve economic performance and overcome the problem of path dependence.The forth was the theory of equity.Based on the classical theories of economic and social justice and detailed contents of equity in healthcare sector,This part analyzed the requirements of equity in health resource distribution,and then described the main methods of equity evaluation.As a whole,Chapter 1 gave a main description and introduction to the theoretical basis of results and policy recommendations.Chapter 2 conducted a study of the overall design.Firstly,based on the theory of dual features of health resources and health capital physician possessed,and the overall hypothesis that the realization of macro policy on equitable distribution of physician needed the supports from micro incentives,it proposed three-level concrete research suppositions for the practices of policies about promoting the equity of physician resources distribution in Shanghai.Secondly,it explained the meaning of the equity of physician resources distribution and general measuring methods.It had been especially emphasized that the requirements of equity on different level medical institutions were relatively different because of different functions.Thirdly,taking the aspects of the influences from the market and government,academic views and index variables used to forecast the needs of physician resources,it figured out the basic structure of the influencing factors of physician resources distribution,and pointed that measureable variables are population and geographical conditions,the development of regional economics,health expenditure,the layout of medical infrastructure,the demands for medical service,economic returns and etc,.Chapter 3 conducted an empirical study on the inequity of physician resources distribution in shanghai.With the further discussion,the analysis focused on the equity of physician resources distribution amongst the districts and counties in Shanghai,as well as the impact of rural-urban gap on existed unfairness.Secondly,according to the functions of different medical institutions,the analysis focused on the equity of physician resources distribution without in tertiary hospitals,as well as general practitioners allocation amongst the districts and counties,and the impact of rural-urban gap on existed unfairness,then the study compared these three types of inequity.Thirdly,the study showed that there was a gap between subjective feelings by investigation,and the results of Gini coefficient to measure the distribution of the physician in community health centers by districts and counties,therefore,it further discussed the results of Gini coefficient to measure the distribution of general practitioners using neighborhoods and townships as units,used geographical information technology(GIS),and,the results still showed that the accessibilities of health services differed a lot between different regions.Fourthly,this part focused on the equity of physician resources distribution without those in tertiary hospitals,and general practitioner allocation amongst the districts and counties,adjusting human resources quality,then it compared these inequity with former one.Fifthly,the inequity of national physician resources distribution was analyzed and compared with the situation in shanghai.All these were helpful to increase the comprehensiveness of this study.Results:according to the above discussions on the equity of national physician resources distribution,physicians without in tertiary hospitals and only in community health services(CHS),the results of Gini coefficient displayed a gradually well tendency and the impacts of rural-urban gap were diminishing.Gini coefficient increases from 0.100 to 0.232 when assessing the equity in the distribution of general practitioners again,using neighborhoods and townships as units instead.However,after adjusting physician resources quality by professional title,the degree of equity increased.Similar to national physician resources,physician resources distribution in communities in Shanghai was in a fair position and showed a more equitable trend.Chapter 4 conducted an empirical study on the influencing factors of physician resources distribution in shanghai.Chapter 2 had already showed that the explained variables were population and geographical conditions,the development of regional economic,health expenditures,the layout of medical infrastructure,demands for medical services,economic returns and etc,.based on this,a panel data model was built and it compared the differences between the influencing factors of national physician resources,physician resources in district hospitals in Shanghai,and those in community health centers in Shanghai.According to the results of regression analysis,the direction and mechanisms of each explained variables to the inequity of physician resources distribution,and the logistical relationship between the influencing factors and the results of inequity were analyzed respectively.It showed that government would intervene in decreasing the inequity of physician resources;the interference was already effective on some determinants;more considerations should be taken into producing positive incentives.Chapter 5 discussed the fundamental causes of the empirical results of equality and determinants from the angel of economics.The influencing factors was divided into two kinds:quantifiable and non-quantifiable ones.All factors used in the panel data model were quantifiable,however,some policy implications was hard to quantify.From the prospective of policy history,simultaneously combined the theory of economics,this chapter analyzed the effects of health human system history on the influencing factors and inequity.Firstly,national personnel and distribution system existed for a long period made the gap of payment between different institutions deeper,which was harmful to physician resources distribution.Moreover,neither salary motivation nor non-salary motivation in community health centers was helpful to attract doctors.Thirdly,from the prospective of positive externality,it explored the causes of lower salary in community health centers and hospitals in suburb,compared with two-level and tertiary hospitals,and found that,such disparities existing in doctor salaries was put forward by current policies,which also aggravated the area inequity of physician resources distribution.The merits and demerits of two methods for mitigating the positive externality,Pigou allowance and property right theory,were compared,the results showed that government subsidy was necessary and should be implemented with market mechanism.Chapter 6 is the main conclusion and policy recommendation.The main conclusions are as follows:The equity of the regional distribution of physician resources in Shanghai did not meet the policy expectation.The distribution of physicians was related to the level of economic development and the demand of medical services.The setting of medical infrastructure and the salary incentive mechanism had a positive effect on the distribution of physician resources.The less use of micro-incentive measures in Shanghai was not benefit to the realization of equity in regional distribution of physician resources.It is suggested that the government should plan and guide the rational flow of physician resources,optimize the salary incentive mechanism to promote the spatial distribution of physician resources,give multiple incentives to mobilize the enthusiasm of physicians at the grass roots level,implement the multi-point practice to promote the flexible distribution of physician resources. |
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