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

Yibin Ao; Qiqi Feng; Zhongli Zhou; Yunfeng Chen; Tong Wang

doi:10.3390/ijerph19116589

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

Int J Environ Res Public Health. 2022 May 28;19(11):6589. doi: 10.3390/ijerph19116589.

Authors

Yibin Ao^{1

2}, Qiqi Feng¹, Zhongli Zhou², Yunfeng Chen³, Tong Wang⁴

Affiliations

¹ College of Environment and Civil Engineering, Chengdu University of Technology, Chengdu 610059, China.
² College of Management Science, Chengdu University of Technology, Chengdu 610059, China.
³ School of Construction Management Technology, Purdue Polytechnic Institute, Purdue University, West Lafayette, IN 47907, USA.
⁴ Faculty of Architecture and the Built Environment, Delft University of Technology, 2628 CD Delft, The Netherlands.

Abstract

The rural three-tier healthcare system is an essential part of the Chinese healthcare service system. To ensure rural residents' equal access to such healthcare services, it is necessary to examine the current status of the healthcare system in rural China and formulate corresponding improvement suggestions. This study therefore collects the data from the China Health Statistics Yearbook, the China Health Yearbook and the China Statistical Yearbook between the years 2004 and 2021 to calculate the Gini coefficient (G), health resource density index (HRDI) and Theil index (T) first, and then perform the Mann-Kendall test afterwards to evaluate the equity of healthcare resource allocation comprehensively. This series of analysis helps in drawing the following conclusions: (1) county and county-level city medical and health institutions (CMHIs) show a higher development trend in comparison with township hospitals (THs) and village clinics (VCs); (2) VCs have higher institutional fairness, while for beds and personnel, CMHIs and THs are more fairly positioned; (3) more specifically for CMHIs and THs, personnel allocation is more fair than beds and institution allocations; (4) the density of healthcare resources in the eastern and central regions is higher than that in the western part, while the intra-regional distribution of beds and personnel in the west and central regions is better than that in the eastern region; (5) intra-regional differences are more significant than inter-regional differences and the fairness according to population distribution is higher than that of geographical area allocation. The results of this study provide theoretical basis for further optimizing the allocation of healthcare resources and improving the fairness of healthcare resources allocation from a macro perspective.

Keywords: equity; resource allocation; rural China; three-tier healthcare system.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

China
Delivery of Health Care*
Health Resources
Humans
Resource Allocation*
Rural Population

Grants and funding

The article processing costs are funded by Delft University of Technology. This study is also jointly supported by the National Natural Science Foundation of China (72171028), the Sichuan Rural Community Governance Research Center (SQZL2021A01 and SQZL2021B03), the Sichuan Disaster Economics Research Center (ZHJJ2021-YB004), the Meteorological Disaster Prediction and Emergency Management Research Center (ZHYJ21-YB06), the Sichuan Rural Development Research Center (CR2101), the Regional Public Management Information Research Center (QGXH21-02), the Open Foundation of the Research Center for Human Geography of Tibetan Plateau and Its Eastern Slope (Chengdu University of Technology) (RWDL2021-ZD001), the Energy and Environmental Policy Research Center, Chengdu University of Technology (CEE2021-ZD02), and Chengdu Philosophy and Social Science Research Base–Chengdu Park Urban Demonstration Area Construction Research Center project (GYCS2021-YB001).