Allocation Status of Human Resources for Primary Care in Highly Focused Districts/Counties during the Comprehensive Reform of Primary Care System in China

Abstract

Objective: To investigate the allocation status of human resources for primary care in highly focused districts/counties from 2013 to 2016 during the comprehensive reform of primary care system in China.

Methods: Based on the data about comprehensive reform of primary care system monitored and surveyed during 2014—2016 by the key monitoring department set up by National Health and Family Planning Commission of the People's Republic of China and Ministry of Finance of the People's Republic of China, we analyzed the number of primary care professionals per 10 000 people, number of general practitioners (GPs) per 10 000 people, doctor-to-nurse ratio, educational attainment and professional and technical title in licensed (assistant) doctors and registered nurses, and training and recruitment of GPs in 34 highly focused districts/counties in 17 provinces during 2013—2016.

Results: The number of primary care professionals in community health service centers (CHSCs) and township hospitals per 10 000 people in 2016 in the highly focused districts/counties was 13.5, 17.1, respectively, which increased by 0.4, 1.4, respectively compared with 2013. The number of GPs in CHSCs and township hospitals per 10 000 people in 2016 was 2.8, 2.0, respectively, which increased by 0.7, 1.0, respectively compared with 2013. The doctor-to-nurse ratio in CHSCs changed to 1:0.80 in 2016 from 1:0.75 in 2013. The doctor-to-nurse ratio in township hospitals was 1:0.63 in 2013, which changed to 1:0.75 in 2016. In CHSCs and township hospitals, the percentage of licensed (assistant) doctors with bachelor's degree or above in 2016 was 53.0% and 28.9%, respectively, which increased by 7.5, 12.2 percentage points, respectively compared with 2013; the percentage of registered nurses with junior college degree or above in 2016 was 70.8% and 63.7%, respectively, which grew by 10.2, 12.8 percentage points respectively compared with 2013; the percentage of licensed (assistant) doctors with senior professional and technical title in 2016 was 8.6% and 3.8% respectively, which rose by 1.8,1.5 percentage points, respectively compared with 2013; the percentage of registered nurses with intermediate professional and technical title or above in 2016 was 21.1%, 17.9%，respectively. Compared with 2013, the number of CHSCs increased by 2.1 percentage point while that of township hospitals decreased by 2.2 percentage points in 2016. Compared with 2013, the number of recruited GPs in 2016 decreased by 1 207, remarkably, the recruited number of persons who made the switch to the profession of GPs after receiving training decreased by 1 264.

Conclusion: In the highly focused districts/counties, the allocation of human resources for primary care has achieved certain degree of improvement, however, it has not reached the requirement yet; the educational level of primary care professionals has improved in some extent, but the number of those with intermediate professional and technical title or above should be increased; there is a shortage of high-quality primary care professionals and a lack of standardized training and post shift training for GPs. In view of this, the construction for primary care professionals should be strengthened and the service capabilities of grassroots medical institutions should be enhanced.