Basic information on health resources allocation and health service provision of Chinese medical institutions
From 2009 to 2018, the quantities of human resources, financial resources and physical resources of Chinese medical institutions showed a significant dynamic upward trend over time, which were statistically significant (P<0.001). Compared with the human resources in 2009, the quantities of the total health workers, practicing (assistant) physicians, nurses, and pharmacists in 2018 have increased by 58.07%, 54.87%, 120.97% and 36.79%, respectively. Compared with the financial resources 2009, Chinese medical institutions’ total revenues, grants from the government and business incomes in 2018 have increased by 246.56%, 354.18% and 223.39%, respectively. Compared with the values in 2009, the total number of equipment at or above CNY 10,000 has increased by 189.30%, building areas has increased by 81.76%, and the number of beds has increased by 90.28% in 2018. The quantities of outpatient visits for Chinese medical institutions significantly increased by 53.80% from 2009 to 2018, and the quantities of inpatient care for Chinese medical institutions significantly increased by 92.01% from 2009 to 2018. (Table 1)
Table 1.Health Resources Allocation and Health Service Provision of Medical Institutions in China, 2009-2018
Indicators
|
2009
|
2010
|
2011
|
2012
|
2013
|
2014
|
2015
|
2016
|
2017
|
2018
|
%a
|
β
|
Pb
|
Human Resources
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Health Workers
/ person
|
7,781,448
|
8,207,502
|
8,616,040
|
9,115,705
|
9,790,483
|
10,234,213
|
10,693,881
|
11,172,945
|
11,748,972
|
12,300,325
|
58.07
|
505594
|
<0.001
|
Practicing ( Assistant) Physicians / person
|
2,329,206
|
2,413,259
|
2,466,094
|
2,616,064
|
2,794,754
|
2,892,518
|
3,039,135
|
3,191,005
|
3,390,034
|
3,607,156
|
54.87
|
141397
|
<0.001
|
Nurses / person
|
1,854,818
|
2,048,071
|
2,244,020
|
2,496,599
|
2,783,121
|
3,004,144
|
3,241,469
|
3,507,166
|
3,804,021
|
4,098,630
|
120.97
|
250044
|
<0.001
|
Pharmacists / person
|
341,910
|
353,916
|
363,993
|
377,398
|
395,578
|
409,595
|
423,294
|
439,246
|
452,968
|
467,685
|
36.79
|
14262
|
<0.001
|
Financial Resources
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Revenues /
million yuan
|
1,186,291.18
|
1,372,627.83
|
1,647,299.36
|
1,998,578.88
|
2,314,754.80
|
2,643,488.53
|
2,953,787.71
|
3,316,611.68
|
3,697,532.03
|
4,111,172.38
|
246.56
|
328116
|
<0.001
|
Grants from the Government /
million yuan
|
133,533.79
|
166,787.42
|
228,599.98
|
271,403.45
|
313,104.35
|
350,062.81
|
432,130.74
|
484,856.63
|
543,225.10
|
606485.23
|
354.18
|
52679
|
<0.001
|
Business Incomes /
million yuan
|
1,034,124.24
|
1,184,722.31
|
1,392,683.83
|
1,653,952.71
|
1,914,745.48
|
2,197,213.63
|
2,414,403.39
|
2,709,985.97
|
3,015,316.40
|
3,344,278.71
|
223.39
|
259127
|
<0.001
|
Material Resources
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Number of Equipment at or above CNY 10,000 / set
|
2,528,796
|
2,824,445
|
3,176,357
|
3,586,935
|
4,172,171
|
4,833,818
|
5,290,731
|
5,924,738
|
6,578,025
|
7315901
|
189.30
|
538630
|
<0.001
|
Building Areas /
million square meters
|
463.34
|
500.98
|
582.48
|
553.87
|
584.75
|
614.42
|
652.56
|
682.26
|
728.55
|
842.17
|
81.76
|
36.32
|
<0.001
|
Beds / unit
|
4,416,612
|
4,786,831
|
5,159,889
|
5,724,775
|
6,181,891
|
6,601,214
|
7,015,214
|
7,410,453
|
7,940,252
|
8404078
|
90.28
|
445482
|
<0.001
|
Service Provision
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outpatient Visits / million
|
5,187.41
|
5,521.32
|
5,944.81
|
6,529.94
|
6,960.52
|
7,258.64
|
7,366.24
|
7,600.34
|
7,847.83
|
7978.16
|
53.80
|
318.10
|
<0.001
|
Inpatient Care / million
|
132.56
|
141.74
|
152.98
|
178.57
|
192.15
|
204.41
|
210.54
|
227.28
|
244.36
|
254.54
|
92.01
|
13.91
|
<0.001
|
a “%” were the value’s growth rates in 2018 compared with the value in 2009; bP values were associated with linear regression analysis.
Basic information on health resources allocation and health service provision of Chinese primary healthcare institutions
Table 2 suggested that in addition to the number of inpatient care, the indicators of health resources and service provision had an apparent upward trend (P<0.001). In comparison with the indicators in 2009, the amounts of health resources had an escalating trend in 2018 by 25.78% for the total health workers, by 40.63% for practicing (assistant) physicians, by 101.86% for nurses and by 23.21% for pharmacists. The amounts of total revenues, grants from the government and business incomes had increased by 173.26%, 628.51% and 93.70% from 2009 to 2018, respectively. As to material resources, the growth rates of total number of equipment at or above CNY 10,000, building areas and the total number of beds were 140.30%, 37.85% and 45.11%, respectively. Furthermore, the outpatient visits in Chinese primary healthcare institutions increased from 3,145.14 million people in 2009 to 4,167.90 million people in 2018, which the growth rate was 32.52%.
Table 2.Health Resources Allocation and Health Service Provision of Primary Healthcare Institutions in China, 2009-2018
Indicators
|
2009
|
2010
|
2011
|
2012
|
2013
|
2014
|
2015
|
2016
|
2017
|
2018
|
%a
|
β
|
Pb
|
Human Resources
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Health Workers
/ person
|
3,152,040
|
3,282,091
|
3,374,993
|
3,437,172
|
3,514,193
|
3,536,753
|
3,603,162
|
3,682,561
|
3,826,234
|
3,964,744
|
25.78
|
79889
|
<0.001
|
Practicing ( Assistant) Physicians / person
|
928,026
|
949,054
|
959,965
|
1,009,567
|
1,050,067
|
1,064,136
|
1,101,934
|
1,145,408
|
1,213,607
|
1,305,108
|
40.63
|
39176
|
<0.001
|
Nurses / person
|
422,262
|
466,503
|
492,554
|
528,178
|
576,630
|
603,900
|
646,607
|
695,781
|
769,206
|
852,377
|
101.86
|
44780
|
<0.001
|
Pharmacists / person
|
119,166
|
125,467
|
125,698
|
127,262
|
130,039
|
131,493
|
134,495
|
138,060
|
142482
|
146,827
|
23.21
|
2745.56
|
<0.001
|
Financial Resources
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Revenues /
million yuan
|
224,128.23
|
225,727.98
|
263,839.57
|
313,849.49
|
353,254.73
|
382,963.06
|
434,885.37
|
482,937.52
|
548,396.95
|
612,463.66
|
173.26
|
43891
|
<0.001
|
Grants from the Government /
million yuan
|
27,142.39
|
40,547.58
|
67,934.89
|
90,153.68
|
104,919.08
|
113,195.10
|
139,736.03
|
157,679.73
|
178,440.41
|
197,735.18
|
628.51
|
18826
|
<0.001
|
Business Incomes /
million yuan
|
189,990.72
|
177,344.00
|
185,422.60
|
197,907.09
|
220,406.55
|
240,606.31
|
262,031.70
|
288,862.13
|
328,332.33
|
368,005.51
|
93.70
|
20538
|
<0.001
|
Material Resources
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Number of Equipment at or above CNY 10,000 / set
|
354,402
|
405,494
|
435,463
|
439,640
|
482,336
|
532,575
|
579,740
|
640,344
|
719,543
|
792,199
|
140.30
|
49674
|
<0.001
|
Building Areas /
million square meters
|
165.75
|
187.05
|
188.97
|
184.43
|
188.57
|
194.18
|
200.38
|
205.55
|
213.04
|
228.49
|
37.85
|
5.35
|
<0.001
|
Beds / unit
|
1,091,277
|
1,192,242
|
1,233,721
|
1,324,270
|
1,349,908
|
1,381,197
|
1,413,842
|
1,441,940
|
1,528,528
|
1,583,577
|
45.11
|
49523
|
<0.001
|
Service Provision
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outpatient Visits / million
|
3,145.14
|
3,350.67
|
3,535.62
|
3,819.96
|
4,044.53
|
4,101.92
|
4,092.13
|
4,118.70
|
4,179.73
|
4,167.90
|
32.52
|
113.92
|
<0.001
|
Inpatient Care / million
|
41.11
|
39.50
|
37.75
|
42.54
|
43.01
|
40.94
|
40.37
|
41.65
|
44.50
|
43.76
|
6.44
|
0.423
|
=0.051
|
a “%” were the value’s growth rates in 2018 compared with the value in 2009; bP values were associated with linear regression analysis.
Proportions of health resources allocation and service provision by primary healthcare institutions
Figure 1a showed the trend of human resource allocation in Chinese primary healthcare institutions over time from 2009 to 2018. The results indicated that the proportion of health workers had decreased year by year, which was statistically significant (P <0.001). The proportion of the number of health workers declined from 40.51% in 2009 to 32.23% in 2018. Among them, practicing (assistant) physicians declined from 39.84% in 2009 to 36.18% in 2018, nurses declined from 22.77% in 2009 to 20.80% in 2018, and pharmacists declined from 34.85% in 2009 to 31.39% in 2018.
In the allocation of financial resources, the proportion of grants from the government has an increase of about 10 percentage points, increasing from 22.33% in 2009 to 32.60% in 2018. On the contrary, the proportions of total revenues and business incomes had a significant down ,which were a decrease of 3.99% and 7.37% in these two departments, respectively, compared with proportions in 2009 (Figure 1b).
As to 2018, among material resources, the proportions of total number of equipment at or above CNY 10,000, building areas and the total number of beds had decreased by nearly 2, 8, and 6 percentage points, respectively. (Figure 1c)
The dynamic change of the proportion of service provision in primary healthcare institutions from 2009 to 2018 was showed in Figure 1d. The number of outpatient visits in primary healthcare institutions dropped from 60.63% in 2009 to 52.24% in 2018, a decrease of approximate 8 percentage points. The proportion of inpatient care decreased from 31.01% in 2009 to 17.19% in 2018, a decline of approximate 13 percentage points. All (P<0.001) showed a significant downward trend.
(The results of all the indicators’ trend tests were shown in Supplementary File 1.To access Supplementary File 1, click on the Supplementary File 1 link in the box to the right of the article online.)