Regional Differences and Influencing Factors of Allocation Efficiency of Rural Public Health Resources in China

Abstract

In the face of increasingly growing health demands and the impact of various public health emergencies, it is of great significance to study the regional differences in the allocation efficiency of the rural public health resources and its improvement mechanism. In this paper, the game competition relationship is included in the evaluation model, and the game cross-efficiency model is used to measure the allocation efficiency of the rural public health resources in 31 provinces of China from 2008 to 2017. Then, the Theil index model and the Gini index model are applied in exploring the regional differences in the allocation efficiency of rural public health resources and its sources. Finally, the bootstrap truncated regression model is used to analyze the influencing factors of the allocation efficiency of the rural public health resources in China. The results show that, first, the total allocation efficiency level of the rural public health resources in China from 2008 to 2017 is relatively low, and it presents a U-shaped trend, first falling and then rising. Second, the changing trend of the allocation efficiency of the rural public health resources in the eastern, central, and western regions of China is similar to that in the nationwide region, and it shows a gradient trend that “the allocation efficiency in the eastern region is high, the allocation efficiency in the western region is low, and the allocation efficiency in the Central region is at the medium level”. However, the gap among the three regions is continually narrowing. Third, the calculation results of the Theil index and the Gini index show that intra-regional differences are the major source of the regional differences in the allocation efficiency of the rural public health resources in China, and the inter-regional differences demonstrate an expansion trend. Finally, the improvement of the education level and the social support level will generally improve the allocation efficiency of the rural public health resources in China and its three regions. The increased governmental financial support and urbanization level will reduce the allocation efficiency of the rural public health resources in China and its three regions. The economic development level, the living conditions and the population density are the important influencing factors of the allocation efficiency differences of the rural public health resources in the three regions. Therefore, on the basis of ensuring the increase of the total supply of the rural public health resources, more attention should be paid to the improvement of the allocation efficiency. Moreover, on the basis of continually narrowing the inter-regional differences among the eastern, central, and western regions, more attention should be paid to the intra-regional differences of the allocation efficiency of the rural public health resources among the different provinces. The various economic and social policies should be constantly optimized to jointly improve the allocation efficiency of the rural public health resources.

Development trend of primary healthcare after health reform in China: a longitudinal observational study

“…In this study, the proportion of health workers in PHIs in the whole health system has decreased year by year, from 40.51% in 2009 to 32.23% in 2018, which was consistent with the results of Zhong et al 41. Moreover, at present, the strengthening PHC measures implemented put too much emphasis on the standardisation and the improvement of hardware conditions of PHIs in China,30 42–44 while ignoring the improvement of PHIs service capacity and the construction of supporting mechanisms, so that the trust of residents in PHIs has not been effectively improved. As a result, the number of outpatient visits and inpatient care in PHIs decreased at an average annual rate of about 0.8% and 1.4%, respectively, resulting in reducing the incomes from charges for services of PHIs and aggravating the shortage of health funds, then forming a vicious circle of ‘the development backwardness of primary healthcare-low attractiveness for patients-more backward of primary healthcare’.…”

Resource Allocation Equity in the China’s Rural Three-Tier Healthcare System

“…However, the agglomeration of high-quality human resources cannot be fully utilized and developed. In particular, the outbreak of COVID-19 at the end of 2019 has brought severe challenges to the public healthcare capacity [ 22 ]. The National Health and Health Commission needs to actively engage in COVID-19 prevention and control, activating the epidemic emergency command system, integrating the forces and operating in a flat manner.…”

The Core of Healthcare Efficiency: A Comprehensive Bibliometric Review on Frontier Analysis of Hospitals

“…The most commonly used inputs in more than 80% of the core publications are hospital beds (intensive care unit beds, emergency beds, psychiatric, chronic, tuberculosis and leprosy beds [ 47 , 74 ]), physicians (specialists and non-specialists), nurses and other medical and non-medical staff (such as ancillary services personnel, pharmacists, laboratory and other technicians, administrative personnel, radiological technologists, midwives, and dietitians [ 43 , 47 ]). They are often measured in Full Time Equivalent (FTE) [ 1 , 41 , 52 , 60 , 67 ].…”

“…Another common but less recurrent input is expenditures. Salaries and other financial or administrative expenditures, such as interest costs [ 72 ], spending on medicines and on purchase of goods and services [ 73 ], rural medical and general healthcare expenditures [ 74 ] are often reported in local currency. Municipal subsidies to cover deficits are also reported in the work of Kawaguchi, Tone and Tsutsui [ 72 ] as an input related to healthcare expenditures.…”

“…The hospital area, medical business area, the number of doctor’s offices and surgical rooms are examples of physical inputs related to the building where the healthcare services are provided in the works of Araújo [ 77 ] and Liu [ 88 ]. The works of Tao Du [ 81 ] and Tao Liu et al [ 74 ] are macro-efficiency evaluations rather than hospital institutional assessments using the number of healthcare institutions in 31 provinces of China as input. Lastly, two unusual and interesting inputs are the service complexity reported in the work of Lee, Yang and Choi [ 71 ], defined as the total number of diagnostic and special services provided by the hospital, and the unmet medical needs reported in the work of Mitropoulos [ 89 ] exhibiting the population seeking healthcare but which cannot have access to it due to financial and service barriers in the healthcare system.…”