Background Under the process of improving the capacity of primary health services, promoting hierarchical diagnosis and treatment, and realising the integration of medicine and prevention, the state has introduced a series of policies to support the cultivation of general practitioners, and to promote the rational distribution of general practitioners' resources. However, at the present stage, the study on the equilibrium of the distribution of general practitioners is still not comprehensive enough, and lacks the attention to both primary health care and disease prevention.
Objective To set up indicators more comprehensively on the basis of previous studies to evaluate the characteristics and equilibrium of the distribution of general practitioners between provinces in China, and to provide theoretical support for the optimal distribution of general practitioner resources.
Methods We collected data from the 2018-2022 China Health Statistics Yearbook, the 2018-2022 China Statistics Yearbook, and the 2021 China Urban Statistics Yearbook from the websites of the National Health Commission, the National Bureau of Statistics, and offline libraries in April 2023, measured interprovincial general practitioner distribution on an absolute level using five indicators: general practitioners per 10 000 population, general practitioners per 10 square kilometres, the general practitioner-inhabitant disposable income ratio, the general practitioner-primary care institution ratio, and the general practitioner-disease prevention institution ratio, combined with descriptive statistics; The GINI coefficient of the five dimensions of population, area, income, primary health care and disease prevention, combined with the Lorenz curve, were used to preliminarily evaluate the provincial relative distribution gap of general practitioners; Further measured the equilibrium of the distribution of the number of general practitioners among provinces by using the five dimensional DAGUM decomposition GINI coefficient, including inter-group GINI coefficient, intra-group GINI coefficient and inter-group GINI coefficient within each region, combined with the analysis of the agglomeration degree of population and area.
Results During 2017 to 2021, the number of general practitioners in China had been growing rapidly. In 2021, the average number of general practitioners per 10 000 population was 2.93, the median was 2.80, and the standard deviation was 0.87; The GINI coefficient of the five-year population dimension was (0.195±0.047), the area dimension was (0.608±0.019), the income dimension was (0.401±0.015), the primary health care dimension was (0.318±0.058), and the disease prevention dimension was (0.393±0.033) ; The annual Lorentz curve of the population dimension deviated slightly from the 45° line, the area dimension and income dimension deviated significantly, and the Lorentz curve of the primary health care dimension and disease prevention dimension deviated moderately; In the result of DAGUM decomposition GINI coefficient, the contribution rate of GINI coefficient between groups was (59.863%±8.785%), the gap between groups was the main reason for the overall gap, and the hypervariable density was (25.959%±10.052%), and the gap within each regional group could not be ignored. Further decomposition results showd that within the region the inter-group GINI coefficient in the area dimension of East China and North China were higher, 0.570 and 0.504, respectively, and the inter-group GINI coefficient of the income dimension in North China was higher, 0.413, and the gap was mainly from Beijing, Tianjin, and Shanghai and the other provinces in the region; The results of agglomeration analysis showd that the values of Qinghai, Henan, Anhui, Guangdong and Jilin provinces were closer to the reasonable value 1, the values of other provinces were different, but they were close to 1 except for Tianjin, Shanxi, Inner Mongolia, Fujian, Hubei, Ningxia and Xinjiang provinces.
Conclusion In absolute terms, the number of general practitioners in China has reached the established development goal. The construction of general practitioners has made remarkable achievements, but the relative number gap between provinces is still large. Although the polarization of agglomeration degree is improving, it still exists. The equilibrium of the distribution of general practitioners needs to be further optimized. We should continue to strengthen the training efforts to promote the growth of the number of general practitioners, At the same time, we should rely on information technology to encourage cross regional assistance and resource sharing.
