Zhongguo quanke yixue (Apr 2022)
Coordinated Development of Primary Care Resource Allocation and Economy as Well as Associate Factors in China: a Fuzzy-set Qualitative Comparative Analysis
Abstract
BackgroundThe allocation of medical resources in China has been in an "inverted triangle" state for a long time. The unreasonable allocation of grass-roots medical resources is difficult to meet the increasingly diversified needs of medical services. The coupling and coordination between the allocation of grass-roots medical resources and economic development will affect the level of regional economic development and the service capacity of grass-roots medical institutions. At present, there is a lack of research on the current situation of their coordinated development and how their influencing factors work through combination.ObjectiveTo assess the level of coordinated development of primary care resource allocation and economy in China, and to determine the associated factors, providing a decision-making basis for further improving medical resource allocation and planning.MethodsThe research was carried out from November 2020 to April 2021. Data were collected from China Health Statistics Yearbook 2019 and China Statistical Yearbook 2019. fsQCA was implemented to assess the influence of the number of licensed (assistant) doctors, number of registered nurses, financial subsidy for part of salary, number of beds, number of primary care institutions, regional gross domestic product (GDP) , regional fiscal revenue, per capita disposable income, and per capita GDP (used as conditional variables) on the level of interconnected, coordinated development level of primary care resource allocation and economic level (the outcome variable) in 31 regions of China.ResultsIn 2018, only the mean level of interconnected, and coordinated development of primary care resource allocation and economy in eastern China (0.61) was within the range (0.6, 1.0] of coordinated development, and that in central China (0.50) was within the transitional harmony range (0.4, 0.6], while that in western China (0.38) was within the range of imbalanced and recessional development[0, 0.4]. The coordinated development of primary care resource allocation and economic level were found to be affected by many factors, and it may be facilitated by four configurations of its associated factors revealed by the configuration analysis: (1) number of beds * number of licensed (assistant) doctors * number of registered nurses * number of primary care institutions * financial subsidy for part of salary* ~ per capita disposable income * ~ per capita GDP; (2) ~ number of beds * ~ number of licensed (assistant) doctors * number of registered nurses * number of primary care institutions * ~ financial subsidy for part of salary* regional GDP * ~ per capita disposable income * per capita GDP; (3) number of licensed (assistant) doctors * number of registered nurses * number of primary care institutions * financial subsidy for part of salary * regional GDP * regional fiscal revenue * per capita disposable income * per capita GDP; (4) ~ number of beds * ~ number of licensed (assistant) doctors * ~ number of registered nurses * ~ number of primary care institutions * financial subsidy for part of salary * regional GDP * regional financial income * per capita disposable income * per capita GDP (* for "and", ~ for "not") . And these four configurations could be classified into three types of paths: primary care resource allocation-driven type, primary care resource allocation and economic balance type, and economic development-driven type.ConclusionThe overall level of coordinated development of primary care resource allocation and economy in China was unsatisfactory, with obvious regional differences, which was mainly affected by the number of registered nurses, regional GDP, and regional fiscal revenue, but may be facilitated greatly by the above-mentioned four configurations of associated factors. Therefore, it is suggested that each region chooses one path to achieve high level of interconnected, and coordinated development of primary care resource allocation and economy according to their own resources and conditions, so as to promote the rational primary care resource allocation, and the coordinated development of medical resources and economic level, thereby improving the level of primary care services in China.
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