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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (3): 477-482. doi: 10.19723/j.issn.1671-167X.2022.03.012

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Analysis of variation trend in health workforce equity allocation in China

Wu-ping ZHOU1,Shu-han YANG2,Nan MU3,Wei-yan JIAN1,*()   

  1. 1. Department of Health Policy and Management, Peking University School of Public Health, Beijing 100191, China
    2. Peking University School of Public Health, Beijing 100191, China
    3. Zhongwei Institute of Nursing Information, Beijing 100086, China
  • Received:2022-02-22 Online:2022-06-18 Published:2022-06-14
  • Contact: Wei-yan JIAN E-mail:jianweiyan@bjmu.edu.cn
  • Supported by:
    National Natural Science Foundation of China(72174007)

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Abstract:

Objective: To analyze the long-term trends of the changes in the equity of China's health workforce allocation to provide a reference for the more balanced and orderly development of China's health system. Methods: The Gini coefficient was used to evaluate the degree of equity in the allocation of health workforce between regions, and the Gini coefficients for the allocation of doctors and nurses based on population and regional gross domestic product (GDP) distribution were calculated respectively. Results: In 2019, the number of licensed (assistant) physicians per 1 000 population in China was 2.77, and the number of registered nurses per 1 000 population was 3.18. The Gini coefficient for the distribution of licensed (assistant) physicians by population was 0.141 in 2002, decreasing to 0.081 by 2014 and then remained stable. The Gini coefficient for the distribution of registered nurses by population was 0.164 in 2002 and decreased to 0.066 in 2018. The Gini coefficient for the distribution of licensed (assistant) physicians by GDP was 0.236 in 2002, decreased to 0.169 in 2013, then increased to 0.183 and remained stable. The Gini coefficient for the distribution of registered nurses by GDP was 0.206 in 2002, decreased to 0.150 in 2013, and then increased each year to 0.180 in 2019. The equity of the allocation of registered nurses by population was worse than the equity of the allocation of licensed (assistant) physicians in 2002, and in 2016, for the first time, exceeded that of licensed (assistant) physicians. Conclusion: Equity in the allocation of health workforce across China has improved, but the improvement in equity between regions has hit a bottleneck, with health workforce allocation in the western regions still relatively scarce. Although nursing workforce allocation equity caught up with licensed (assistant) physicians, the number of licensed (assistant) physicians is close to that of developed western countries, while there is a large gap in registered nurses. It is recommended that the relevant authorities make good long-term planning for health workforce, further increase the policy for the introduction of health workforce in the western region, and increase the supply of healthcare services in the western region with the help of digital transformation of healthcare and internet healthcare. At the same time, they should further increase investment in resources for higher nursing education and actively plan to cope with the ageing population.

Key words: Health manpower, Health care rationing, Gini coefficient

CLC Number: 

  • R192

Table 1

Trends in the number of health workforce in China, 2002-2019"

Year Number of health technicians (×104) Number of health technicians per 1 000 population Doctor-nurse ratio
Licensed (assistant) physician Registered nurse Licensed (assistant) physician Registered nurse
2002 184.4 124.7 1.47 1.00 1:0.68
2003 194.2 126.6 1.53 1.00 1:0.65
2004 199.9 130.8 1.57 1.03 1:0.65
2005 204.2 135.0 1.56 1.03 1:0.66
2006 209.9 142.6 1.60 1.09 1:0.68
2007 212.3 155.9 1.61 1.18 1:0.73
2008 220.2 167.8 1.66 1.27 1:0.76
2009 232.9 185.5 1.75 1.39 1:: 0.80
2010 241.3 204.8 1.80 1.53 1:0.85
2011 246.6 224.4 1.82 1.66 1:0.91
2012 261.6 249.7 1.94 1.85 1:0.95
2013 279.5 278.3 2.04 2.04 1:1.00
2014 289.3 300.4 2.12 2.20 1:1.04
2015 303.9 324.1 2.22 2.37 1:1.07
2016 319.1 350.7 2.31 2.54 1:1.10
2017 339.0 380.4 2.44 2.74 1:1.12
2018 360.7 409.9 2.59 2.94 1:1.14
2019 386.7 444.5 2.77 3.18 1:1.15

Figure 1

Change in the Gini coefficient for health workforce allocation, 2002-2019"

Table 2

Licensed (assistant) physicians and nurses per 1 000 population by province in 2002, 2013, 2019"

Province Region Number of licensed (assistant) physician per 1 000 population Number of registered nurse per 1 000 population
2002 2013 2019 2002 2013 2019
Beijing East 3.32 3.63 4.83 2.73 3.95 5.25
Shanghai East 2.55 2.37 3.01 2.16 2.78 3.74
Zhejiang East 1.57 2.39 3.22 0.99 2.29 3.45
Shandong East 1.44 2.38 3.12 1.00 2.46 3.38
Jiangsu East 1.38 2.07 3.01 0.98 2.13 3.30
Hainan East 1.48 1.82 2.40 1.22 2.27 3.22
Guangxi East 1.07 1.76 2.31 0.85 2.00 3.06
Tianjin East 2.65 2.27 3.35 1.96 2.11 2.99
Guangdong East 1.17 1.87 2.33 0.97 1.93 2.85
Fujian East 1.28 1.87 2.40 0.91 2.06 2.81
Hebei East 1.44 2.06 3.07 0.74 1.53 2.48
Liaoning North-east 2.14 2.37 2.90 1.69 2.37 3.25
Jilin North-east 2.10 2.32 3.23 1.46 1.98 3.24
Heilongjiang North-east 1.70 2.20 2.87 1.20 2.02 3.00
Hunan Middle 1.31 1.93 2.87 0.82 1.90 3.62
Hubei Middle 1.54 2.02 2.59 1.15 2.21 3.28
Shanxi Middle 1.99 2.49 3.02 1.15 2.12 3.12
Henan Middle 1.06 1.89 2.54 0.72 1.84 2.82
Anhui Middle 1.00 1.65 2.27 0.67 1.73 2.68
Jiangxi Middle 1.14 1.57 2.14 0.84 1.75 2.67
Shaanxi West 1.63 1.96 2.76 1.00 2.35 3.81
Ningxia West 1.72 2.15 2.89 1.18 2.10 3.39
Yunnan West 1.19 1.61 2.42 0.80 1.58 3.36
Inner Mongolia West 2.05 2.53 3.23 1.08 2.13 3.33
Sichuan West 1.43 2.14 2.65 0.74 1.95 3.24
Chongqing West 1.34 1.83 2.61 0.73 1.84 3.24
Qinghai West 1.79 2.32 2.95 1.08 2.01 3.21
Gansu West 1.37 1.77 2.50 0.88 1.61 3.17
Guizhou West 0.95 1.54 2.33 0.55 1.62 3.15
Xinjiang West 1.99 2.32 2.65 1.48 2.48 3.02
Xizang West 1.63 1.63 2.58 0.61 0.76 1.66

Figure 2

Lorentz curve for the allocation of national licensed (assistant) physicians and registered nurses (by population and GDP) A, distribution of licensed (assistant) physicians by population; B, distribution of licensed (assistant) physicians by GDP; C, distribution of registered nurses by population; D, distribution of registered nurses by GDP."

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