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. 2019 Aug 7;16(16):2813.
doi: 10.3390/ijerph16162813.

Examining the Multi-Scalar Unevenness of High-Quality Healthcare Resources Distribution in China

Meng Yu  1   2 , Shenjing He  3   4 , Dunxu Wu  1   2 , Hengpeng Zhu  5 , Chris Webster  1   2
Affiliations

Examining the Multi-Scalar Unevenness of High-Quality Healthcare Resources Distribution in China

Meng Yu et al. Int J Environ Res Public Health. .

Abstract

Healthcare disparity is, to a large extent, ascribable to the uneven distribution of high-quality healthcare resources, which remains insufficiently examined, largely due to data unavailability. To overcome this barrier, we synthesized multiple sources of data, employed integrated methods and made a comprehensive analysis of government administrative structures and the socio-economic environment to build probably the most inclusive dataset of Chinese 3-A hospitals thus far. Calibrated on a sample of 379 hospitals rated by a reputable organization, we developed a realistic and viable evaluation framework for assessing hospital quality in China. We then calculated performance scores for 1246 3-A hospitals, which were aggregated and further analyzed at multiple scales (cities, provinces, regions, and economic zones) using general entropy indexes. This research shows that the fragmented governance and incoordination of "kuai" and "tiao" is rooted deeply in China's legacy of centrally-planned systems, and has had a far-reaching yet partially contradictory influence over the contemporary distribution and performance of healthcare resources. Additionally, the unevenness in the distribution of healthcare resources is related closely to a city's administrative rank and power. This study thus suggests that the policy design of healthcare systems should be coordinated with external socio-economic transformation in a sustainable manner.

Keywords: 3-A hospitals; evaluation framework; general entropy indexes; high-quality healthcare resources; hospital quality; multi-scalar unevenness.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Data Collection and the Data Sorting Process. Source: Compiled by the authors.
Figure 2
Figure 2
China City’s Administrative Level vs. 3-A Hospitals Distribution. Source: Compiled by authors.
Figure 3
Figure 3
The Ratio of the Number of Patients served by Community-based Healthcare Centers to Patients Served by Tertiary Hospitals across 31 Provinces. Source: China Health Statistics Yearbook (2016); Note: The sequence of the 31 provinces is the same as the province list in Table 5; Xinjiang Production and Construction Corps (XPCC) is excluded here since its data is not recorded as a province in the yearbook.
See this image and copyright information in PMC

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