中国医师资源演变(2003-2021):数量、质量、结构和地理分布

IF 3.9 2区 医学 Q1 HEALTH POLICY & SERVICES
Yu Xiao, Zhou Zhang, Chun-Mei Xu, Jian-Ying Yu, Ting-Ting Chen, Shu-Wan Jia, Na Du, Shao-Yi Zhu, Jing-Hui Wang
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引用次数: 0

摘要

医生是医疗保健系统不可或缺的一部分,对维护公众健康至关重要。自2003年市场化医疗改革出现问题以来,中国实施了一系列医疗体制改革,以促进医疗资源的公平分配。这些改革措施对医生队伍的影响还有待系统评估。方法:数据来源于2003 - 2021年的《中国卫生统计年鉴》。我们对医师的数量、质量和结构进行了详细的描述性统计分析。计算基尼系数评价全国医师分配公平性,并利用泰尔指数进一步分析省际和省内医师劳动力不平等趋势。采用全球Moran’s I和热点分析对医师劳动的空间异质性和聚类性进行研究。结果:医师人数由2003年的187万人增加到2021年的429万人,年均增长率为4.72%。男女比例从1:0.69变为1:0.92。医师主要学历为本科以上(45.9%)。结论:19年来,尽管医生的数量和质量都有所提高,但年轻医生数量的减少和地区差异的加剧给我国带来了挑战。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evolution of physician resources in China (2003-2021): quantity, quality, structure, and geographic distribution.

Introduction: Physicians are an indispensable part of the healthcare system, crucial for maintaining public health. Since the issues in market-oriented healthcare reform emerged in 2003, China has implemented a series of healthcare system reforms to improve the equitable distribution of medical resources. The impact of these reform measures on the physician workforce has yet to be systematically assessed.

Methods: Data were sourced from the China Health Statistics Yearbook from 2003 to 2021. We conducted a detailed descriptive statistical analysis of physicians' quantity, quality, and structure. The Gini coefficient was calculated to evaluate national physician distribution equity, and the Theil index was further used to analyze interprovincial and intraprovincial inequality trends in the physician workforce. Global Moran's I and hotspot analysis were employed to examine the spatial heterogeneity and clustering of physician labor.

Results: The number of physicians increased from 1.87 million in 2003 to 4.29 million in 2021, with an average annual growth rate of 4.72%. The male-to-female ratio changed from 1:0.69 to 1:0.92. The main educational level of physicians elevated to a bachelor's degree (45.9%). However, the proportion of young doctors (< 35 years) declined from 41.1 to 26.0%. The Gini coefficient decreased from 0.140 in 2003 to 0.071 in 2021, and the Theil index dropped from 0.091 to 0.057. Decomposition of the Theil index revealed that overall differences in physician distribution primarily stemmed from intraprovincial inequality rather than interprovincial inequality. Global Moran's I decreased from 0.304 in 2003 to 0.109 in 2015 and then increased to 0.444 in 2021. Hotspot analysis showed uneven physician distribution, with high-value clusters in northern regions and low-value clusters in southern regions.

Conclusions: Over the past 19 years, despite improvements in the quantity and quality of physicians, the decline in young physicians and worsening regional disparities pose challenges.

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来源期刊
Human Resources for Health
Human Resources for Health Social Sciences-Public Administration
CiteScore
8.10
自引率
4.40%
发文量
102
审稿时长
34 weeks
期刊介绍: Human Resources for Health is an open access, peer-reviewed, online journal covering all aspects of planning, producing and managing the health workforce - all those who provide health services worldwide. Human Resources for Health aims to disseminate research on health workforce policy, the health labour market, health workforce practice, development of knowledge tools and implementation mechanisms nationally and internationally; as well as specific features of the health workforce, such as the impact of management of health workers" performance and its link with health outcomes. The journal encourages debate on health sector reforms and their link with human resources issues, a hitherto-neglected area.
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