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      Distribution and equity trends for general practitioners in China from 2012 to 2015

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          Abstract

          Objective: This study aimed to identify the distribution and equity trends for general practitioners (GPs) in China from 2012 to 2015 and to provide evidence to guide the discipline’s development of general practice and for policy-making.

          Methods: On the basis of data from the National Health Statistics yearbooks, the distribution and equity trends for GPs from 2012 to 2015 were analyzed with the Lorenz curve and Gini coefficient as indictors of health equity.

          Results: From 2012 to 2015 the number of GPs increased at rates ranging from 9.3% to 32.5%, while the number of registered GPs increased at rates ranging from 32.6% to 37.2%. In 2015 the average number of GPs was 1.38 per 10,000 people (among the 31 provinces the highest rate was 3.90 per 10,000 people in Zhejiang and the lowest rate was 0.50 per 10,000 people in Xizang) and 1.98 per 100 km 2 (among 31 provinces the highest rate was 89.23 per 100 km 2 in Shanghai and the lowest rate was 0.01 per 100 km 2 in Xizang). From 2012 to 2015 the Gini coefficients weighted by population were 0.31, 0.29, 0.26, and 0.25 respectively, while the Gini coefficients weighted by geographical area were 0.74, 0.72, 0.72, and 0.72 respectively.

          Conclusion: The number of GPs increased rapidly in China; however, the proportion of registered GPs was unsatisfactory, and there were inequities among the different provinces. The government should launch integrated strategies to encourage GP trainees to become registered GPs and optimize the distribution and equity of GPs.

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          Most cited references 18

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          China's human resources for health: quantity, quality, and distribution.

          In this paper, we analyse China's current health workforce in terms of quantity, quality, and distribution. Unlike most countries, China has more doctors than nurses-in 2005, there were 1.9 million licensed doctors and 1.4 million nurses. Doctor density in urban areas was more than twice that in rural areas, with nurse density showing more than a three-fold difference. Most of China's doctors (67.2%) and nurses (97.5%) have been educated up to only junior college or secondary school level. Since 1998 there has been a massive expansion of medical education, with an excess in the production of health workers over absorption into the health workforce. Inter-county inequality in the distribution of both doctors and nurses is very high, with most of this inequality accounted for by within-province inequalities (82% or more) rather than by between-province inequalities. Urban-rural disparities in doctor and nurse density account for about a third of overall inter-county inequality. These inequalities matter greatly with respect to health outcomes across counties, provinces, and strata in China; for instance, a cross-county multiple regression analysis using data from the 2000 census shows that the density of health workers is highly significant in explaining infant mortality.
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            Inequality in the distribution of health resources and health services in China: hospitals versus primary care institutions

            Background Equity is one of the major goals of China’s recent health system reform. This study aimed to evaluate the equality of the distribution of health resources and health services between hospitals and primary care institutions. Methods Data of this study were drawn from the China Health Statistical Year Books. We calculated Gini coefficients based on population size and geographic size, respectively, for the indicators: number of institutions, number of health workers and number of beds; and the concentration index (CI) for the indicators: per capita outpatient visits and annual hospitalization rates. Results The Gini coefficients against population size ranged between 0.17 and 0.44 in the hospital sector, indicating a relatively good equality. The primary care sector showed a slightly higher level of Gini coefficients (around 0.45) in the number of health workers. However, inequality was evident in the geographic distribution of health resources. The Gini coefficients exceeded 0.7 in the geographic distribution of institutions, health workers and beds in both the hospital and the primary care sectors, indicating high levels of inequality. The CI values of hospital inpatient care and outpatient visits to primary care institutions were small (ranging from -0.02 to 0.02), indicating good wealth-related equality. The CI values of outpatient visits to hospitals ranged from 0.16 to 0.21, indicating a concentration of services towards the richer populations. By contrast, the CI values of inpatient care in primary care institutions ranged from -0.24 to -0.22, indicating a concentration of services towards the poorer populations. The eastern developed region also had a high internal inequality compared with the other less developed regions. Conclusion Significant inequality in the geographic distribution of health resources is evident, despite a more equitable per capita distribution of resources. Richer people are more likely to use well-resourced hospitals for outpatient care. By contrast, poorer people are more likely to use poorly-resourced primary care institutions for inpatient care. There is a risk of the emergence of a two-tiered health care delivery system.
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              South Africa’s protracted struggle for equal distribution and equitable access – still not there

              The purpose of this contribution is to analyse and explain the South African HRH case, its historical evolution, and post-apartheid reform initiatives aimed at addressing deficiencies and shortfalls. HRH in South Africa not only mirrors the nature and diversity of challenges globally, but also the strategies pursued by countries to address these challenges. Although South Africa has strongly developed health professions, large numbers of professional and mid-level workers, and also well-established training institutions, it is experiencing serious workforce shortages and access constraints. This results from the unequal distribution of health workers between the well-resourced private sector over the poorly-resourced public sector, as well as from distributional disparities between urban and rural areas. During colonial and apartheid times, disparities were aggravated by policies of racial segregation and exclusion, remnants of which are today still visible in health-professional backlogs, unequal provincial HRH distribution, and differential access to health services for specific race and class groups. Since 1994, South Africa’s transition to democracy deeply transformed the health system, health professions and HRH establishments. The introduction of free-health policies, the district health system and the prioritisation of PHC ensured more equal distribution of the workforce, as well as greater access to services for deprived groups. However, the HIV/AIDS epidemic brought about huge demands for care and massive patient loads in the public-sector. The emigration of health professionals to developed countries and to the private sector also undermines the strength and effectiveness of the public health sector. For the poor, access to care thus remains constrained and in perpetual shortfall. The post-1994 government has introduced several HRH-specific strategies to recruit, distribute, motivate and retain health professionals to strengthen the public sector and to expand access and coverage. Of great significance among these is the NHI Plan that aims to bridge the structural divide and to redistribute material and human resources more equally. Its success largely hinges on HRH and the balanced deployment of the national workforce. Low- and middle-income countries have much to learn from South African HRH experiences. In turn, South Africa has much to learn from other countries, as this case study shows.
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                Author and article information

                Journal
                FMCH
                Family Medicine and Community Health
                FMCH
                Compuscript (Ireland )
                2009-8774
                2305-6983
                July 2017
                September 2017
                : 5
                : 2
                : 155-162
                Affiliations
                1Peking University Third Hospital, Beijing, 100191, China
                2Peking University Health Science Center, School of Public Health, Beijing, 100083, China
                Author notes
                CORRESPONDING AUTHOR: Weiwei Liu, Peking University Third Hospital, Beijing, 100191, China, E-mail: c_lww@ 123456126.com
                Article
                FMCH.2017.0115
                10.15212/FMCH.2017.0115
                Copyright © 2017 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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                Self URI (journal page): http://fmch-journal.org/
                Categories
                China Focus

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