Study On The Fairness Of Ophthalmic Resources And Service Capabilities In Shanghai Medical Institutions

Background: Visual impairment is a major public health and social issue which involves people's livelihood.Although we have made breakthroughs in the prevention of blindness since the liberation of our country,China still has the largest number of blind and visually impaired patients in the world,causing a pressing challenge of blindness prevention and treatment.As a mega city in China,Shanghai has achieved certain results in the prevention and treatment of eye diseases,yet there are still gaps between the goal of “eliminating avoidable blindness” and the standards of developed countries.In order to rationally allocate medical resources and improve the capability of ophthalmic services,we must first have a clear and comprehensive understanding of the current situation.Shanghai is the frontier of China's economic and social development with leading medical resources,highest population density,and the highest aging rate among major cities in China.The investigation and fairness analysis of the current situation of ophthalmic medical resource allocation and service capacity in Shanghai has important reference value for exploring the future development direction and configuration characteristics of ophthalmic medical resources of cities in China.Methods: The ophthalmic medical institutions registered in the administrative districts(counties)under the jurisdiction of Shanghai were selected as research objects.Three sets statistics of the general information,routine examinations,surgical project development,human resources and the usage data of ophthalmic examination equipment and surgical equipment,in 2013,2015 and 2017,were acquired on 2014,2016 and 2018 respectively.The Gini coefficient and the Theil index were used for resource fairness analysis.Results: The average number of outpatients per institution in Shanghai in 2013 was19945.05,which was much higher than that of the national and eastern regions.In2015,this figure was 20,534,with an increase of 2.95%.The average annual hospitalization per institution was 434 in 2013,and it was 34.79% higher in 2015.There is no statistically significant difference between suburban and city in the number of ophthalmic medical institutions,outpatient clinic and emergency treatment in Shanghai in 2013.By contrast,there are statistically significant differences in the number of ophthalmic beds,discharges,and operations.The data from 2015 and 2017 are similar.In 2017,the average number of ophthalmologists in medical institutions in downtown Shanghai was 12.28,and it was only 6.43 in the suburbs.In 2013,the medical institution in the downtown carried out 1817 cataract surgeries and 310 vitreous surgeries on average,in comparison with 380 and 41 in suburbs during the same period.In 2013,Shanghai has 51 ophthalmologists 13 ophthalmic technicians and 40 nursing staffs per one million people,close to the standard of upper-middle-income countries.The number of ophthalmic health technicians in Shanghai was 2,650 in 2013,2,749 in 2015 and 2,451 in 2017.In 2013,the average number of 10 major ophthalmic equipment was 2.16 per institute in contrast to 2.29 in 2015 and 2.30 in 2017.There is unfairness in the number of ophthalmic medical institutions and the number of designated beds distributed by population or distributed by geographical area.Nevertheless,the regional differences are reduced.Ophthalmic human resources are unfair according to population distribution and geographical area distribution.The unfairness caused by regional differences among ophthalmologists and ophthalmology nurses is decreasing while fluctuating with researchers in ophthalmology.Commonly used diagnostic and treatment equipments in ophthalmology,including slit lamp,tonometer,fundus/anterior camera,optometry and surgical microscope,are unfair according to population distribution and geographical area distribution.Conclusion: The overall service capacity of Shanghai eye care institutions from 2013 to 2017 is higher than the national average level,with a slow growth.There are still significant differences between suburban and city in the ophthalmic medical servicecapacity and medical resources in Shanghai,indicating an unfair phenomenon in resource allocation.With regard to the Shanghai ophthalmic human resources,there are sufficient ophthalmologists while short of the assisted technicians,optometry staff and nursing staff.From 2013 to 2017,the total number of medical equipment in Shanghai ophthalmic medical institutions grew slowly,and the growth of equipment corresponded to the changes in disease spectrum.