KONG Ling-da, LIU Ya-dan, WU Zhi-ang

(1. School of Business Administration, Shenyang Pharmaceutical University, Shenyang 110016, China;

2. National Instisutes for Food and Drug Control, Beijing 100050, China)

Analysis of China’s Health Care Resource Allocation

KONG Ling-da1, LIU Ya-dan2, WU Zhi-ang1

(1. School of Business Administration, Shenyang Pharmaceutical University, Shenyang 110016, China;

2. National Instisutes for Food and Drug Control, Beijing 100050, China)

Objective To provide references for rational allocation of China’s health care resources. Methods Descriptive analysis and cluster statistics were conduced to analyze China’s health care resource allocation. Results and Conclusion Health care resource allocation is unreasonable to some degree and countermeasures are raised.

health care reform; health care resource; developmentstrategy

In the history of Chinese medical and health services, we must admit the traditional health management system has played a great role in promoting the residents’ health level and improving the quality of life. According to World Bank statistics, the infant mortality is coming down from 47 per thousand before reform and opening up to 19 per thousand. Average life expectancy is going up from 43.43 years in the 1960s to 74.8 years in 2010. The former Minister of Health, Chen Zhu said at a news conference that Chinese people's average life expectancy would reach 77 in 2020, which would be equal to the average level of developed countries. Basic medical insurance continues to expand and the establishment of basic medical insurance system would be completed in 2012, which is mainly composed of three basic medical insurance. It can cover more than 95% of the urban and rural residents and the total number will be more than 1.3 billion at the end of 2011. But with the improvement of material life, residents put forward multi-level and diversif i ed requirements for health services. At the same time, due to high demand for medical many problems occurred, too. For example, patients have diff i culty in getting medical service and the cost is high in hospital which has led to tension in doctor-patient relation.

1 The descriptive analysis

In the medical and health service system, medical institutions bear various contradictions from all walks of life. Patients generally believe that it is difficult to get a suitable medical service, for instance, it is hard to register in the hospital and there are not enough beds for patients. People are doubted about the insufficient supply. Medical institutions, as the main body to provide health care services, are developing rapidly along with the growth of population. As is shown in Figure 1, the number of hospitals was 9, 000 in 1978 and it has reached 22, 000 in 2011, which has tripled. But the population from the original 1 billion increased to 1.3 billion. We can see that before 2000 the increase in the number of medical institutions and population was the same, and then the population growth was slowing down while the hospital growth was going up.

The above method is commonly used to analyze the health resources by medical institutions, but a careful analysis from the perspective of growth, the result is not the same. In this study, in order to show the differentiation clearly, we select the cumulative growth rate in 5 years. For hospital’s fast development after the open and reform, along with better statistics records due to the perfect medical mechanism, we choose the data from 1980s. As is shown in Figure 2, the hospital’s cumulative growth rate is higher than that of the total population, but far lower than the urban population growth rate. Especially the frequent medical accidents occurred in 2000, which had to do with the related national policies and the tend of health care industry development.

Under the guidance of “allowing some people to get rich first”, China vigorously promoted the urbanization which lead to the higher urban residents’ per capita disposable income. But at the same time, some problems such as an increase in inequality and the growing wealthgaps between urban and rural regions occurred as well. A considerable population migrated from the rural and third line cities to large cities due to the decline of the agriculture and the rise of urban industry and service industry. The fi xed population and the number of the fl oating population in cities have been growing. But the medical and health system and its service can not match with the growing population in time and this situation also led to the low medical institutions’ efficiency. In 2003, the outbreak of SARS (severe acute respiratory syndrome (SARS)) made the medical and health resources allocation problem become the public issue of concern[1].

Figure 1 Population and hospital quantity change

Figure 2 Hospital and population growth rate changes

The phenomenon of irrational allocation of the medical and health resources exists in different regions in China. As is shown in Table 1, it is a descriptive analysis of the data from health statistics yearbook issued by the Ministry of Health and the statistical objects are from 31 provincial regions in China in 2011 on medical and health resources allocation. The statistics of this article comes from the basic medical resource. In order to be quantitative, the main indexes include the number of medical institutions, beds and medical personnel. But considering the environment, population and economic level in different regions, we also, take birth rate, age structure, education level into consideration.

Table 1 China’s 31 provinces in 2011 medical and health resources allocation

As is shown in Table 1, the allocation of health resources in 31 provinces by the end of 2011 differed greatly. At worst, the gap on the one thousand hospital statistics was not obvious, but from the perspective of the distribution of tertiary hospital, the maximum value was 85, and the minimum was only 2. Therefore, the gap is very obvious. From the standard deviation, the dispersion degree of health personnel and the total assets was big. The f i gures showed that there was a huge gap for software conf i guration and hardware configuration in medical institutions. From the angle of deviation degree, we can see all the data value is greater than 0 which means the data distribution is prone to the left and it is close to zero. At the same time, divided the values by standard error and the ratio U is signif i cantly greater than 1.645, which means the distribution is not normal at all. Through the analysis of the data, we get the result that China's medical and health resources allocation is irrational and most of the regions do not have enough medical and health care.

2 Cluster analysis

In order to show the provincial medical and health resources distribution clearly, we carry out the cluster analysis of 31 provincial medical and health resources[2]based on the data in Table 1. The result is shown in Table 2.

This article uses the traditional hierarchical cluster analysis to reflect the characteristic of regional allocation of health resources. We make the tree analysis diagram by analyzing the basic indicators and data and classifying the similar regions into one group. Calculating methods for distance function includes the shortest distance method, the longest distance method, gravity method, the median distance method, the distance between group method and the sum of squared residuals method, etc. Through a large number of experiments we find that the distance between group method and the deviation analysis are good and steady. But from the perspective of specific analysis, the analysis of two variables will get too large number of categories which is not easy to sum up, so the f i nal choice is the Ward’s Method and it makes the minimum deviation. Because we select the continuous variable data, then we use square Euclidean distance measurement method.

In this analysis foundation, on the premise of the social and economic factors, China’s medical and health resources can be roughly divided into five categories, and the average index of each category is shown in Table 2 and Table 3. From Table 2, we can see the various indicators in different categories, and based on the characteristics of different categories we can get the following conclusions.

Figure 3 Cluster analyses of medical and health resources in China’s 31 provinces in 2011

Table 2 Cluster analysis of medical and health resources

Table 3 Cluster analysis of social and economic factors

Class 1: The cities have great share of medical and health resources and high level of medical development. This category includes Beijing, Shanghai and Tianjin, three China’s municipalities directly under the central government. These cities have great share of medical resources such as the number of per thousand beds, per thousand doctors and other important indexes like per capita income, household income, which are much higher than other cities. If we take these factors such as the size of the three cities and population, the number of the third class hospitals, per thousand health workers into consideration, we can find that they possess a large number of medical resources.

Class 2: Provinces have big share of medical and health resources and high level of medical development, but per capita medical level is not good. This category includes Liaoning, Jiangsu, Zhejiang, Shandong and Guangdong. These economically developed provinces have more medical and health resources, especially the high level of medical development such as tertiary hospitals. But due to the dense population in some parts of these provinces, it causes resources tension and one of the highlighted problems is the index of per thousand hospitals.

Class 3: Some provinces do not have big share of medical and health resources and high levels of medical development, but the per capita medical level is good. This category includes Inner Mongolia, Heilongjiang, Jilin, Shanxi, Fujian and other provinces. The quantity of medical resources in these provinces is relatively scarce, but because of geographical reasons, the population is not big and the per capita medical level can be average.

Class 4: Some provinces have adequate medical and health resources and high level of medical development, but fewer resources per capita. This category includes Hebei, Henan, Hubei, Hunan, Anhui, Guangxi, Gansu, Chongqing, Sichuan, Jiangxi, Yunnan, Guizhou and other provinces. Though such populous provinces have more medical and health resources, per capita consumption are low. Two indicators such as per thousand hospitals and per thousand physicians can ref l ect the problem.

Class 5: Some provinces have small share of medical and health resources, especially the high level of medical development and fewest resources per capita. This category includes Hainan, Tibet, Qinghai, Ningxia, Xinjiang and other provinces. These provinces locate quite far geographically with less population and scarce medical and health resources. Xinjiang is better and other provinces lack tertiary hospitals. Therefore, medical and health resources are suff i cient in most parts of the country except for fewer provinces with scarce resources.

3 Results and discussion

Through the above analysis we can conclude that, compared to medical treatment in the developed countries, China’s medical and health resources are still inadequate, especially in basic medical facilities and medical services. But compared with most developing countries, China is in the leading position. Due to the unreasonable medical resources allocation, a large number of resources are in the cities, especially in large cities and primary care in community, village and towns is low. This leads to the problem that patients have difficulties in getting medical treatment and the cost is high in hospitals. The reason resulting in such problems is the irrational medical and health resources allocation, improper distribution of medical institutions and poor management eff i ciency.

Resources integration refers to optimizing the internal resources with the external resources on the basis of the existing resources, and making the limited resources play more important role. According to the international experience, China should plan and integrate the existing health resources to better serve her people.

[1] China’s Health Statistics Yearbook and from 2006 to 2012 [R]. National Health and Family Planning Commission of the People’s Republic of China, 2006-2012.

[2] China’s Health Statistics in 2012 [R]. National Health and Family Planning Commission of the People’s Republic of China, 2013.

Author’s information: WU Zhi-ang, Professor. Major research area: Social pharmacy. Tel: 024-23986542, E-mail: wuerla501@126.com