Measuring the inequalities in healthcare resource in facility and workforce: A longitudinal study in a municipal city of China

Abstract BackgroundPrevious literature has proved that the uneven distribution of healthcare resources leads to growing inequalities between the rich and the poor with respect to wellbeing and health outcomes. Reducing inequalities in healthcare resource will eliminate avoidable disparities caused by differences in geographic location, or by avoidable segmented areas in the opportunity of having adequate access to healthcare, enjoying life and pursuing one's life plans. The study, by integrating traditional methods with spatial statistics, aimed to measure time trends of inequalities in the geographical distribution of health facility and workforce ,and to detect the priority areas to optimize health resource reallocation in Shanghai, China from 2010 to 2016.MethodsThe study used secondary data from Shanghai health Statistical Yearbook and Shanghai Statistical Yearbook from 2010 to 2016. Five indicators on health resources, including the numbers of health institutions, beds, technicians, doctors and nurses were employed to quantitatively measure the healthcare resource in Shanghai. Theil index was calculated to estimate the global geographic inequalities of these resources in Shanghai. Global and local spatial autocorrelations were performed to calculate the Moran’s indices to illustrate the spatial changing patterns and identify the priority areas for healthcare resource allocation.ResultsShanghai’s healthcare resources showed generally decreasing trends of inequalities from 2010 to 2016. However, there still existed an unchanged over-concentrated distribution in healthcare facility and workforce density among different districts in Shanghai. There was a significant spatial autocorrelation in the density distribution of all resources, and some priority areas were identified for resources re-allocation policy planning.ConclusionThe findings of the study demonstrated the effectiveness of the new health reform policy on reducing the inequality of the health resrouce allocation. However, more detailed area-specific healthcare resource allocation planning and policies are required to balance the workforce distribution at district level and institution distribution at rural level. Certain geographical areas (low-low and low-high cluster areas) should be considered as policy and collaboration priorities to realize health equality in Shanghai.