Measurement,Causes And Evidence Of The Maldistribution Of Doctors Between Urban And Rural Areas In China

The concentration of high-quality Doctors Human Resources(DHRs)in urban areas' high-grade public hospitals is a distinctive feature of China's maldistribution problem of DHRs,and which is significantly different from other countries.This dissertation holds that the hierarchy system of public hospitals is the main cause of this problem,and the doctors' hierarchy preference practice behavior is the key influence mechanism.First of all,the hospital hierarchy spawned the doctors' hierarchy preference practice behavior because the high-grade public hospitals in urban areas have a large numbers of stable patient volume,and which is of great significance for doctors to acquire the Learning Curve Effect(LCE)through Learning By Doing so as to improve their clinical diagnosis ability more quickly.Therefore,high-quality doctors generally choose to practice in the urban areas' high-grade public hospitals;And secondly,the doctors' hierarchy preference practice behavior led to the formation of the maldistribution of DHRs between urban and rural areas in China.Considering that the high-grade public hospitals in China concentrate in urban areas,and the counties and rural areas are mainly low-grade public hospitals.So that,the emergence of the doctors' hierarchy preference practice behavior is bound to be accompanied by the deterioration of the maldistribution of DHRs between urban and rural areas in China.In order to verify the above analysis conclusion,we empirically examine the effects of the proportion of Class A tertiary hospitals on the maldistribution of DHRs between urban and rural areas in China at the provincial level.On the one hand,the proportion of Class A tertiary hospitals is calculated by the ratio of the Class A hospital's number in each province to the total number of hospitals.On the other hand,the maldistribution of DHRs is calculated by using the Amended Weighted Coefficient of Variation(AWCV).Furthermore,we use the provincial panel data of 2004~2016 years in China and construct a provincial and year levels' Two-Way Fixed Effects Model(T-W FE)with one year lagged proportion of Class A tertiary hospitals as the core independent variable.So that this model can relieve the endogenous problem arisen from missing variables and reverse causality to some extent.The empirical results show that:(1)Every 10% increase in the proportion of Class A tertiary hospitals in provincial samples will lead to a significant increase in the maldistribution of DHRs by 13.64%~25.26%;(2)This effect does not change significantly due to the difference of provinces' level of economic development and health finance investment.Moreover,we proved that our empirical results are high robustness by using the Theil-T Index and the Theil-L index to reassess the dependent variable and removing the minority autonomous regions from the samples.The enlightenment of this dissertation is that it is the fundamental way to solve the maldistribution problem of DHRs between urban and rural areas in China by reforming the mechanism of China's medical service system characterized by public dominance,hierarchy classification and urban and rural dual development structure,rather than focusing solely on strengthening internal management.