Zhongguo quanke yixue (Jun 2023)
Current Status and Equity of Primary Care Resource Allocation in Tibet
Abstract
Background The primary care facilities in a region play a vital role in maintaining the health of the local residents as the gatekeeper. At present, there is a lack of research on the allocation of primary care resources in Tibet, a remote autonomous region in northwestern China. Objective To analyze the current situation and equity of the allocation of primary care resources in Tibet, to provide a scientific basis for optimizing the allocation of primary care resources in Tibet. Methods Data used in this study were from six volumes (2015—2020) of Tibetan Health Statistics Yearbook and China Health Statistics Yearbook, as well as the human resource information in the Primary Care Direct Reporting System of Tibet Health Commission from 2015 to 2020. Descriptive analysis was used to analyze the allocation of primary care resources in Tibet from 2015 to 2020. Gini coefficient and concentration index were used to evaluate the equity of primary care resource allocation in Tibet in 2020. Results The number of beds in primary hospitals in Tibet increased from 3 393 in 2015 to 3 867 in 2020. The number of (assistant) practicing physicians per 1 000 people increased from 0.37 in 2015 to 0.61 in 2020. The utilization rate of beds in primary hospitals decreased from 30.9% in 2015 to 11.5% in 2020. The daily visits per primary care physician decreased from 13.80 in 2015 to 9.95 in 2020. The daily number of hospital bed days of care per primary care physician decreased from 0.44 in 2015 to 0.10 in 2020. In 2020, the Gini coefficients of health resources allocated in primary hospitals according to population in Tibet were greater than 0.3, which were better than those allocated according to geography. The difference in the concentration degree between number of beds, number of health technicians, number of (assistant) practicing physicians or number of registered nurses and population, was -6.93, -4.50, -2.50, -6.15, respectively, in Lhasa, and 0.05, -0.21, -0.80, -0.22, respectively, in Changdu, and -0.88, 0.10, 0.47, -0.05, respectively, in Shannan, but was all greater than 0 in other cities. Conclusion The primary health workers in Tibet showed a trend of "low growth in number, low capability and low efficiency". It is suggested to pay attention to regional characteristics to improve the allocation standards of primary care resources, promote the equity of the allocation of primary care resources based on geographical classification, reform the employment mechanism and human resource management system in primary care, innovate the system and mechanism of aiding Tibet and establish a new model of financial investment at the primary level.
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