Equity analysis of Chinese physician allocation based on Gini coefficient and Theil index

Background Unequal allocation of medical physician resource represents one of major problems in the current medical service management in China and many other countries. This study is designed to analyze the current distribution of physicians in 31 provincial administrative regions in China, to estimate the fairness of the distribution of physicians and provide a theoretical basis for the improvement of the allocation of physicians. Methods This study took physicians from 31 provincial administrative regions in China as the study objects, and the data were obtained from the China Health Statistics Yearbook 2019 and the official website of the National Bureau of Statistics of China. Calculation of the Gini coefficient (G) and the Theil index (T) were carried out by drawing the Lorenz curve. The fairness of present physician location in 31 provincial administrative regions in China was analyzed from the perspective of distribution by both population and service area. Results The Gini coefficients of medical physicians in China are 0.003 and 0.88 by population and by service area, respectively. This shows that the distribution of medical physicians is fair basing on population, and there is little difference in the number of physicians per 1000 population in different regions. However, the physician distribution basing on service area is highly unfair and shows a large gap in the number of physicians per square kilometer between different regions. In general, Beijing, Zhejiang, Shanghai, Jiangsu, Shandong, and Tianjin are higher than the overall level of 31 provincial administrative regions. In addition, the number of medical physicians in Zhejiang, Shandong, Beijing and Jiangsu is over-provisioned. Conclusion Bridging the number of medical physicians in different regions is a key step to improve the equity of physicians’ resource allocation. Thus, findings from this study emphasize the need to take more measures to reduce physician quality differences between regions, balance and coordinate medical resources. This will increase the access of all citizens to quality medical services.

“扁鵲見蔡桓公”——對一則古代案例的倫理學回顧

LANGUAGE NOTE | Document text in Chinese; abstract also in English.扁鵲是中國先秦時期著名的醫生，同時也是中國傳統醫學和醫學倫理的奠基者和實踐者之一。他在與蔡桓公的幾次會面中作出的對話，有著豐富的道德內涵，展示了傳統醫患之間的一種具有特色的醫學倫理。中國傳統的醫學倫理和職業精神並不把醫生僅僅看成是一個純粹的技術性職業，而是賦與其中豐富的人生道德內涵和家國天下的思想，所以在西方醫患關係中被認為是十分重要的知情同意問題，在中國傳統的醫患關係中雖然也存在，但並沒有成為中國傳統醫患關係的主體。與之相反，中國傳統的醫患關係因為是建立在“上醫醫國”的文化土壤中的，醫患之間的關係也是在綱常倫理的維度中加以調適的，所以這種關係不僅僅是今天意義上的權利和義務、知情和同意等法律屬性的關係。Bian Que is the earliest known Chinese physician of the Pre-Qin era (ca. 700 B.C.E), whose name is often associated with physicians of the highest medical caliber. One legend tells of how when Bian Que was in the feudal state of Cai, he visited the Lord Huan and told him that he had a serious disease. The Lord Huan thought Bian Que was trying to profit from the fears of his patients and declined the offer for treatment. Eventually, Lord Huan’s condition got worse. The last time Bian Que went to see Lord Huan, he knew that the lord would soon die and escaped from the state. This essay considers the ethical implications of the legend, such as the moral duty of the physician and the nature of the physician-patient relationship. Did Bian Que violate informed consent when he failed to tell the lord he would die of the disease if not treated immediately? The author concludes that the role of physician in ancient China was quite different from what one sees today. Thus, modern ideas and concepts such as informed consent and the language of rights cannot be applied to the case of Bian Que.DOWNLOAD HISTORY | This article has been downloaded 182 times in Digital Commons before migrating into this platform.

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