Trend and equity of general practitioners’ allocation in China Based on the Data from 2012-2017
Authors: Yu Qianqian , Yin Wenqiang , Huang Dongmei , Sun Kui , Chen Zhongming , Guo Hongwei , Wu Di 
Published: September 2020

Abstract
Background: General practitioners are the gatekeepers of the health of the residents living in a particular area. The equity of their allocation is of great significance to the residents' access to essential medical and health services and forms the rational pattern of graded diagnosis and treatment in China. This study aims to evaluate the trend and equity of general practitioners' allocation at the national level in mainland China from 2012-2017 and provide a reference for regional health planning and the rational distribution of general practitioners. Methods: We treated the data of general practitioners from 22 provinces, 5 autonomous regions, and 4 municipalities (except Taiwan, Hong Kong Special Administrative Region, and Macao Special Administrative Region) as research materials. We obtained the population and geographical area of each region from the China Statistical Yearbook (2013-2018). The general practitioners' data were obtained from China Health and Family Planning Yearbook (2013-2018). We used the Lorenz curve, Gini coefficient, and agglomeration degree to analyze the equity of general practitioners in population and geographical area allocation in China. Results：In 2017, the total number of general practitioners in China was 252,717, and the number of general practitioners per 10,000 residents was 1.82. The number of general practitioners accounted for 7.45% of the total number of practicing (assistant) doctors. From 2012 to 2017, the population-based Gini coefficient for general practitioners reduced from 0.31 to 0.24, while the geographical area-based Gini coefficient remained unchanged at 0.73. The agglomeration degree based on population increased from 0.72 to 0.73 in the western regions including Tibet (0.403) and Shaanxi (0.513). Moreover, the agglomeration degree in the Eastern region reduced from 1.477 to 1.329, while that in Zhejiang province, Beijing and Shanghai were much higher than 1. The agglomeration degree in the Middle region rose from 0.646 to 0.802, but that in Heilongjiang and Hunan provinces was lower. The agglomeration degree based on the geographical area increased from 0.270 to 0.277 in the western region, among which Tibet, Qinghai, and Xinjiang had an agglomeration degree of less than 0.1. In the eastern region, the agglomeration degree reduced from 1.447 to 1.329, while that in Shanghai, Beijing, Tianjin, and Zhejiang province was much higher than 10. The agglomeration degree increased from 1.149 to 1.423 in the middle region, among which Heilongjiang had the lowest agglomeration degree.Conclusions: The number of general practitioners in China has increased significantly, but the total allocation is still insufficient. China has a fair allocation of general practitioners' resources based on population, and the allocation is continuously improving. However, the equity distribution based on geographical area is low and has not changed much in recent years. The distribution of general practitioners in different regions is uneven with large regional differences. In the western region, there is a shortage of general practitioners in terms of population and geographical area, while in the eastern region, there is an excessive concentration of resources. We propose that concerned departments should establish and improve the incentive and performance appraisal mechanisms of general practitioners to improve the occupational attractiveness. The departments can use the Internet+ to empower the service capacity and efficiency of general practitioners. The Government should increase its input for the western region and take measures to encourage the eastern region to support the western region. We should also strive to develop medical education in the western region to generate better general practitioners and achieve balanced development in different regions.