“十三五”期间我国卫生人力资源配置现状及公平性分析

Research on the Current Situation and Fairness of China's Health Human Resource Allocation during the "13th Five-Year Plan" Period

目的了解“十三五”期间我国卫生人力资源配置现状,并分析其配置的公平性,为我国卫生人力资源的合理配置提供建议。方法根据统计年鉴数据,通过描述性统计、卫生资源集聚度方法分析“十三五”期间我国31个省、自治区和直辖市及东中西部地区卫生人力资源配置的公平性。结果2016-2020年我国卫生人力资源总体呈现增长趋势,但依旧存在机构间、区域间以及城乡间分配不均衡。机构层面,医院的人力资源总量持续高于基层医疗卫生机构,卫生技术人员占比逐年提高。地区层面,东部地区千人口执业(助理)医师数、千人口注册护士数、千人口药师(士)数均高于中西部地区。其中,绝对数值相差最大的是2019年千人口执业(助理)医师数,城乡差距为0.48。城乡层面,城市每千人口卫生技术人员、执业(助理)医师、注册护士数始终高于农村,各项指标均在农村数量的2倍以上。卫生人力资源配置公平性存出明显的区域差异,东部地区的集聚度值大于中、西部地区。各省份比较发现,东部地区中上海的各类卫生技术人员集聚度最高,中部地区中河南各类卫生技术人员集聚度最高,而西部地区中重庆卫生技术人员集聚度最高。结论“十三五”期间我国卫生人力资源配置存在机构间、区域间以及城乡间分配不均衡的问题,且我国卫生人力资源按人口配置的公平性优于按地理配置的公平性。政府应兼顾地理和人口等多方面因素,缩小卫生人力资源配置地区差异,均衡卫生人力资源配置,优化卫生人力资源按地理配置的公平性。

Objective The aim of this study is to gain an understanding of the current status of health human resource allocation in China during the 13th Five-Year Plan period,and to analyze the equity of such allocation.Furthermore,this research aims to provide recommendations for the rational distribution of health human resources in China.Methods This study employed descriptive statistical analysis to assess the present situation.Additionally,health resource concentration methods were utilized to analyze the equity of health human resource allocation across the 31 provinces,autonomous regions,municipalities,as well as the eastern,central,and western regions of China during the 13th Five-Year Plan period.Results The findings indicated an overall increasing trend in health human resources during the period from 2016 to 2020.However,significant disparities in distribution persisted among different institutions,regions,and urban and rural areas.At the institutional level,there was a consistent imbalance in the allocation of human resources,with hospitals having a higher workforce compared to primary healthcare institutions.The proportion of health technical staff had shown a steady rise over the years.From a regional perspective,the eastern region exhibited higher numbers of practicing(assistant)physicians,registered nurses,and pharmacists per thousand population compared to the central and western regions.Notably,the largest difference in absolute numbers was observed in 2019,where the shortage of practicing(assistant)physicians per thousand population between urban and rural areas reached 0.48.Furthermore,urban areas consistently maintained significantly higher numbers of health technicians,practicing(assistant)physicians,and registered nurses per thousand population compared to rural areas,with the former consistently exceeding the latter by more than double.In terms of equity in the allocation of health human resources,significant regional disparities were observed from both geographical and demographic perspectives,with concentration values consistently higher in the Eastern region compared to the central and western regions.Among the provinces,Shanghai in the eastern region exhibited the highest concentration of various categories of health technical staff,while Henan in the central region and Chongqing in the western region de-monstrated the highest concentration of health technical staff.Conclusion This study reveals unequal distribution of health human resources across institutions,regions,and urban and rural areas during the 13th Five-Year Plan period in China.The findings highlight the superiority of equity based on demographic considerations rather than geographical considerations in the allocation of health human resources.In order to address these disparities and achieve a more balanced distribution of health human resources,it is recommended that the government take into account various factors,including population and geography,and optimize the geographic allocation of health human resources.