| Health human resource is the most important component of health resources, and it is the decisive factor of the health care development. It not only reflects a country or region's overall quality of health services, but also is the most important factor to main individual health. In a country or region, adequate number of the healthcare professionals, quality, reasonable structure, balance, and scientific management, not only influence health care development, but also affect economic development and social balance.Medical education is the major avenue to outsource medical professionals for health care, the training of medical personnel quality will directly affect the level of community health services, related to the nation's health and social stability. The development of higher medical education level of a country and society is of great significance.Therefore, comprehensive examination of the current state of the health human resources and medical education and the status quo of medical education and health human resources supply and demand balance in Guangdong Province is instrumental in the strategic planning for the development of health human resources.Objective:1.To examine the basic characteristics of health care human resources and medical education from 1999 to 2008, and to explore any shortcomings in these areas 2.To forecast the demands of health care human resources and medical education from 2009 to 2015, in the next 7 years, to analyze the demand of health care professionals and the supply from the medical education in order to analyze the state of demand and supply.3.To propose a development plan:to investigate the main factors contributing to the imbalance between health human resources demand and supply thought medical education in Guangdong Province, to make scientific suggestions on health human resources and medical higher education development plan, in order to provide valuable evidence for government decision-making.Methods:Systematic literature review was conducted to examine the domestic and foreign related research; descriptive analysis was used to describe the data collected from current situation; grey prediction method was used to predict the supply and demand of human resources and medical higher education; "supply and demand theory" was used to analyze supply and demand balance of the health workforce.Results:1. Health Human Resources in Guangdong ProvinceThe total number of healthcare professionals is 479,462 in 2008, accounting for 7.8% of the total health workforce, which ranked first in the country, of which 383 876 were medical staff. Per thousand resident population in the province, there were 4.02 health workers,1.51 practicing (or assistant) physicians, and 1.42 registered nurses.Professional structure:Physicians and nurses accounted for 37.6% and 35.4% of the total health care professionals. The proportion of pharmacists, testing, imaging, and other health care technicians were 7.6%,4.3%,1.9%, and 13.2%, respectively. The physician technician ratio is 1:0.72, while it is 1:1 required by the Ministry of Health. The physician nurse ratio is 1:0.94 in Guangdong Province, which is far away from the ration of 1:2 required by the Ministry of Health.Educational background:Until April 2008, in general, The largest proportion of the Guangdong health human resources is 39.5% for people with secondary degrees, followed by associates and bachelors, which accounted for 30.2% and 21.3%, respectively, while only 3.5% is master prepared. Licensed physicians have the highest educated group, while most of professionals in nursing, pharmacy, technician, testing, and others only had secondary education after they graduated from junior high school. Therefore, the education level among health care workers in our province is relatively low.Title structure:According to technical qualifications, only 8.6% of the overall number of health personnel is at a senior level. The majority of health care professionals are only at junior levels; with 11.8% of them has no title at all. Except for practicing physicians, in all of the other professionals, most of them are at junior levels, accounting for more than a third of the whole, mainly because with the structure of their qualifications and expertise relating to the low level. The proportion of those medical managers with no professional title is big, which is not beneficial for increasing the level of medical management.Age distribution:The health care professionals working in Guangdong Province are relatively young, among which 42.6% are between 25-34 years of age. Only 6.4% are over the age of 55. For those who held a management position, most of them are 35-44, which is related to the time accumulation of working experience in practice. Thus, they are relatively older. The different age structure between managers and common professionals are beneficial for the professional development in medical care.In 1998, the number of health care professionals in Pearl River Delta, Eastern Guangdong Wing, Western Guangdong Wing, and Northern Guangdong Mountain District were 137278,32566,34478, and 47891, respectively. While in 2008, the numbers reached 255909,34823,40613, and 52531, which had annual average growth rates of 6.43%,0.67%,1.65%, and 0.93%. Thus, the number of health care workers in Pearl River Delta region is increasing, while the other three regions had slowing increasing rates.2. Prediction of human resources for health Using the 1999-2008 data as baseline, we used the grey prediction method in SPSS 13.0 to predict the number of health care professional, technicians, physicians, and nurses in short term and mid-term; we found that each prediction model is excellent. The results showed that in 2009-2015, the total number of health care professionals will be increased to 675 938, which is 196,476 higher than 2008. In average, the annual demand of health workers in Guangdong Province is approximately 28068, of which 5635 were needed for physicians with an increase of 39,446 people, add 11,378 nurses with an increase of 79,645.The number of health professionals per thousand population will increase from 4.02 persons in 2008 to 4.19 in 2010, and to 5.11 persons in 2015. The number of physicians per thousand people will increase from 1.51 to 1.54 persons in 2010, and to 1.76 in 2015. The number of nurses per thousand population will rise from 1.42 to 1.55 in 2010, and 2.06 in 2015. Average annual number of all the indicators can not be achieved by 2010 in Guangdong Province "Eleventh Five" Health personnel planning targets. The number of health workers per thousand population can't even reach this criteria till 2015. Thus, there is a big gap in the Guangdong health human recourses.The physician nurse ratio will increase from 1:0.94 to 1:1 in 2010, and to 1:1.17 in 2015. Using the requirement of the Ministry of Health, the physician nurse ratio is still far less than 1:2, therefore, we could see there is a substantial need for nurses.3. Medical Higher EducationIn 2008, we have 20 medical institutions in Guangdong Province. There were a total of 91,144 students, which had an increase of 438.64% and 439.13% from 1998. The number of graduates increased from 3400 in 1998 to 20,870 people in 2008.The number of students enrolled in medical institutions increased from 6414 in 1999 to 25,803 in 2008. During the past 10 years, the number of enrolled students in medical colleges increased by 302.29%, which had an average annual increase rate of 16.73%. Master students had the largest increase rate; undergraduate students had the lowest increase rate. From the enrollment scale, undergraduate and post-secondary students are the mainstream of the enrolled medical student in Guangdong Province. From the graduate scale, influenced by the enrolled students, undergraduate and post-secondary graduates are also the mainstream. Therefore, the problem of having a large overall size and a fast-growing and oversized post-secondary education becomes more prominent.Through examination of the major setting among Guangdong medical institutions, the setting of different medical professions is comprehensive, and the numbers keep increasing. In 2005, all the majors covered 8 categories and 17 professions in medicine of those mentioned in the "National Medical Profession Course Catalog", till 2008, it has covered eight categories and 23 medical profession. But they are mainly focused on nursing, pharmacy, traditional Chinese medicine, medical testing, rehabilitation technology, and other medical-related professions.4. Medical higher education and health human resources Demand Forecast and AnalysisMedical colleges are the cradle for training health professionals; they are also the supplier of health human resources. Similarly, using the grey prediction method in SPSS13.0, we forecasted the number of medical graduates in short-and mid-terms. We found that the prediction model is excellent, compared with the prediction results from the health human resources demand, the results showed that state of the supply and demand in Guangdong Province in 2009-2015:except for 2010, when graduates and the number of health workers is similar to average annual demand, the supply-demand ratio 1.2:1, the number of graduates of other years were greater than the number of health personnel needs. Supply> demand trends, the trend was increasing every year. By 2015, the number of graduates reached 94,953 people, supply and demand ratio will be 2.6:1, which is far beyond the actual requirements.Thus, we could learn that the health human resources supply is greater than demand, according to "supply and demand theory" in economics, in the next few years, there will be a large number of medical graduates who could not find a job, health human resource will be a huge waste. Therefore, in the next few years, the health human resource department should not expand the number of medical student recruitment. Instead, they should accommodate the demand the human resource market and medical technology development level to increase the overall quality and efficiency in medical training, through adjustment of different training levels, setting majors, and increase the overall quality of medical students.5. DiscussionThe major problems for the health human resources in Guangdong Province are: the total human resources for health is abundant but the number of health personnel per thousand population is low; imbalance on the professional structure; the overall low quality of the health workforce; imbalanced allocation of health human resources in different residential areas.The reality of the medical higher education:enrollment scale is too large, growing too fast; unreasonable major setting; training level is too low; the supply of health workforce is in general greater than its demand.Through examination of the issues between health human resources in Guangdong Province and medical higher education, we have the following recommendations:(1) The general principle for the development of human resources for health should be structural adjustment, quality improvement, and balanced development:we should increase the total numbers of health care professional, particularly the number of physicians and nurses, we could try to increase the number of health care workers per thousand population; we should strengthen on-job training and continuing education to improve the overall quality of health personnel; we should also strengthen macro-control, to achieve balanced development of health personnel across different regions.(2) Medical higher education reform measures should include:1) strictly control the size of enrollment to ensure the quality of medical education:using health personnel demand forecast results to guide the plan for education enrollment; and improving the overall teaching quality in medical institutions.2) adjust the professional structure:medical professional structure of higher education settings should be consistent with the real demand of the health care professionals. During the process of development of clinically relevant medical professions, we cannot ignore the development of nursing, medical, prevention, and health management professions.3) adjust the level of medical education:compression of the mid-level medical personnel education, and strengthen the training of high-level professionals.4) strengthen career guidance and promote balanced regional development of health manpower allocation:through provision of incentives to guide career choices among medical graduates, thus medical professionals could really "go to the lower level hospital, stay at the same hospital, and available when needed", thus contributing to regional balanced development of health personnel allocation.
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