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Addressing the Licensed Doctor Maldistribution in China: A Demand-And-Supply Perspective.

ABSTRACT: Background: The maldistribution of licensed doctors is one of the major challenges faced by the Chinese health sector. However, this subject remains underexplored, as the underlying causes of licensed doctor distribution have not been fully mapped out. To fill the research void, this study theoretically modeled and empirically measured various determinants of licensed doctor distribution from both the supply and demand sides while taking the spillover effect between the adjacent geographical units into consideration. Methods: The theory of demand and supply is adopted to construct a research framework so as to explain the imbalance in the licensed doctor distribution. Both direct effects and spillover effects of the supply-side factors and demand-side factors are empirically measured with the spatial panel econometric models. Results: The health service demand was found, as expected, to be the major driving force of the licensed doctor distribution across the nation. That is, the increase in health services demands in a province could significantly help one unit attract licensed doctors from adjacent units. Unexpectedly but intriguingly, the medical education capacity showed a relatively limited effect on increasing the licensed doctor density in local units compared with its spillover effect on neighboring units. In addition, government and social health expenditures played different roles in the health labor market, the former being more effective in increasing the stock of clinicians and public health doctors, the latter doing better in attracting dentists and general practitioners. Conclusions: The results provide directions for Chinese policy makers to formulate more effective policies, including a series of measures to boost the licensed doctor stock in disadvantaged areas, such as the increase of government or social health expenditures, more quotas for medical universities, and the prevention of a brain drain of licensed doctors.

SUBMITTER: Zhu B

PROVIDER: S-EPMC6571941 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:The licensed doctor misdistribution is one of the major challenges faced by China. However, this subject remains underexplored as spatial distribution characteristics (such as spatial clustering patterns) have not been fully mapped out by existing studies. To fill the void, this study aims to explore the spatio-temporal dynamics and spatial clustering patterns of different subtypes of licensed doctors (i.e., clinicians, traditional Chinese medicine doctors, dentists, public health doctors, general practitioners) in China. METHODS:Data on the licensed doctor quantity and population during 2012-2016 was obtained from the National Health (and Family Planning) Yearbook. Functional boxplots were used to visualize and compare the temporal trends of densities of different subtypes of licensed doctors. This study adopted two complementary spatial statistics (space-time scan statistics and Moran's I statistics) to explore the spatio-temporal dynamics and spatial clustering patterns of licensed doctor distribution in China. The former was used to explore the spatial variations in the temporal trends of licensed doctor density during 2012-2016, and the latter was adopted to explore the spatial changing patterns of licensed doctor distribution during the research period. RESULTS:The results show that the densities of almost all subtypes of licensed doctors displayed upward trends during 2012-2016, though some provincial units were left behind. Besides, spatial distribution characteristics varied across different subtypes of licensed doctors, with the low-low cluster area of general practitioners being the largest. CONCLUSIONS:The misdistribution of licensed doctors is a global problem and China is no exception. In order to achieve a balanced distribution of licensed doctors, the government is suggested to introduce a series of measures, such as deliberative policy design and effective human resource management initiatives to educate, recruit, and retain licensed doctors and prevent a brain drain of licensed doctors from disadvantaged units.

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Addressing the Licensed Doctor Maldistribution in China: A Demand-And-Supply Perspective.

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