| BackgroundHealth resources refer to the total of all inputs of various health services, including hardware (which includes the whole monetary and human resources inputs for health services) and software (including health information, health technology, health management, health service capacity, etc.). For example, staff size of health professionals, number of beds, health cost as a share of government financial expenditure, the doctor-nurse ratio and so on, which are all considered as important measures of health resources in certain periods at one country or region. However, given the limitation of health resources in one country, how to reasonably, equally and efficiently allocate health resources have been one of priorities in the field of health service research. In the process of health system reform across the world, emphasis were given to reasonable and equal allocation of health resources as well as the efficiency of productivity.On Jan 2009, the State Council approved the "Notice of deepen health system reform" and "implementation project of deepening health system reform during 2009 to 2011", the new health reform was then launched. This is a leading document to establish China specific health system, and gradually achieve the universal health coverage. The document of health reform states that health planning should be strengthened.Shandong province is no doubt a province with a strong economy and huge population. Accompanied with the rapid economic development, health system were also seen a significant advancement; number of health institutions, number of health staffs, number of beds were all located at leading positions across the country. But several challenges still exit. One of those was the inequality of health resources allocation and low efficiency of utilization. At current stage, research concerning equity of health resources at Shandong province, analysis on problems within health recourse allocation within the province, exploring ways and strategies to improve the equality level of health resources allocation, could provide more accurate and timely information for government agencies, and provide theoretical basis for deepen health system reform and health planning at Shandong province, in order to facilitate the development of health issues.ObjectivesAnalyzing the trend of allocation and equity change of health resources at Shandong province, identifying changes as well as problems of health resources allocation, and exploring ways and solutions to improve the equal allocation of health resources, in order to produce evidences for policymaking of government agencies, to strengthen the development of health system at Shandong province.Materials and Methods"China Statistic Year Book", "China Health Statistic Year Book", "Shandong Province Statistics Year Book" and "Shandong Province Health Statistic Year Book" between 2007 and 2014 were used for data collection. Descriptive statistics, Lorenz curve and Gini Coefficient, as well as concentration curve and concentration index were applied to analyze health resources allocation and the trend of equity change before and after medical reform in Shandong Province ranging from 2006 to 2013.Results1. Health resources enjoyed by per person was relatively low despite of the large volume of health resources at Shandong Province. Volume of health resources is huge being the leading level in China. However, as a province with large population, health resource enjoyed by each person is low, which needs further improvement.2. Structure of health resources allocation should be optimized. Problems like significant gap between urban and rural and unbalanced doctor-nurse ratio have resulted in the undue provision of health services in urban area, low efficiency and feasibility of local health services. Insufficient health resources in primary institutions has leaded to larger and larger differences in terms of health status among population.3. The total volume of health resources and per person occupied resources have been overall improved after the health reform, but space still needed to improve. Rapid developments have occurred in health resources of Shandong province, but should be kept up with the population growth and economic development, considering factors such as large population, aging, and urbanization, and quality as well as efficiency of health services needed to be improved, health resources allocation merit further optimizing and strengthening.4. The equality of population distribution of health resources at Shandong province is relatively high but no substantive improvements were found after the health reform.5. Geographical allocation of health resources is relatively equal, but lower than that of population distribution and few improvements after the new health reform. Certain regions still have significant gaps.6. Health resources in Shandong province is concentrated in the rich cities which has not changed much after the new health reform.Recommendations and suggestions1. Clarify the responsibility of government and strengthening its predominant role. Government should be flexible and efficient in terms of administrative intervention in the field of health. Government should exert its leadership in the field of medical services, undertaking responsibilities of guidance, innovation and supervision, establish a good environment of health markets. Health resources serving as public goods need administrative intervention.2. Strengthening health human resources and optimizing resources allocation Shortage of health human resources and inequality allocation of health resources are typical problems in the world and have gained great attentions. Governments should encourage the reasonable flow of health human resources through improving the quantitative and quality of health professionals to improve the equal allocation of health resources.3. Strengthening primary health care and narrowing the gap of resources between urban and rural. As for unbalance distribution of health resources at Shandong Province, government should facilitate development of county health hospitals and township health centers, provide solid foundation for new cooperative medical scheme. County hospitals and township health centers are medical centers in rural areas. Municipal governments should pay special focus on capacity building of township health center and central township health centers, raising financial investment in medical equipment provision and building construction of county hospitals and township health centers, enabling its health resources up to the national criteria.4. Establishing reasonable health planning to facilitate the coordinated development of health system in the whole province. Local health planning refers to identify the goal, model, scale and spend of health development at local regions according to the socio-economic development, population health status and need of health services, etc. Through reasonable allocation of health resources, adopting interventions and solutions with low cost, to improve the comprehensive capacity of health service provision, enabling local residents gain access to equal, effective, convenient and inexpensive health services, and ultimately the achieve the goal of protecting and improving population health.5. Through multi-sources financing, strengthening roles of public finance and social capital To solve the problems of unbalanced investment of health resources should not solely rely on government since this is not the only responsibility of government but also the social and private health contributions. Therefore, public finance should be more active in facilitating the equal distribution of health resources across regions and populations. |
PDF Full Text Request