Differences in Regional Distribution and Inequality in Health-Resource Allocation on Institutions, Beds, and Workforce: A Longitudinal Study in Shanghai, China

Background: The distribution of health-care resources is a critical component of health-care access, and equity is a basic principle of health-resource allocation, and foundational to achieving fairness in the provision of health services. China and its local Shanghai’s government has implemented measures to allocate health-care resources with the equity as one of the major goals since 2009.The aim of this study was to analyze differences in regional distribution and inequality in health-resource allocation on institutions, beds, and workforce in Shanghai over 7 years.Methods: A longitudinal survey using 2010–2016 data, which were collected for analysis. The study was conducted health-resource allocation on institutions, beds, and workforce in Shanghai, China. Five health-resource indicators were used to measure health-resource distribution at the city and district levels. Furthermore, the Theil index was calculated to measure inequality of health-resource allocation.Results: All quantities of health-care resources per 1000 people increased across Shanghai districts from 2010 to 2016. Compared with suburban districts, the central districts had higher ratios on five health-care resource indicators, and faster average growth in the bed and nurse indicator, and slower growth in the institution, technician and doctor indicator. The Theil indices of the technicians, doctors, nurses and beds had higher values than that of institutions every year from 2010 to 2016; furthermore, the Theil indices of the indicators, except for doctors in hospitals, all exhibited downward time trends.Conclusions: Increased health-care resources and reduced inequality of health-resource allocation in Shanghai during the 7 years indicated that the measures taken by the Shanghai government in the new round of healthcare reform in China since 2009 had been successful. Meanwhile there still existed regional difference between urban and rural areas and inequality between institution and workforce, especially doctors.