What about the health workforce distribution in rural China? An assessment based on eight-year data.

Introduction: Health, as a fundamental human right, and its fairness and equality have gradually been reiterated and emphasized around the world. The inequality in health workforce distribution is common in China and many other developing countries. However, it is unknown whether the economic conditions and insufficient supply of village physicians in rural areas worsens health inequality. This study and article aimed to explore and discuss the inequality in health workforce in rural China. Methods: Inequality in health workforce distribution of rural China as well as trends of village physician-to-population ratios from 2009 to 2016 were measured by the Lorenz curve/Gini coefficient and Theil L index, and compared between four divisions: eastern, central, western and north-eastern. Results: The Gini coefficient of village physicians compared with population from 2009 (0.062) to 2016 (0.038) showed absolute equality in rural China. In contrast, the Thiel L index from 2009 (0.380) to 2016 (0.347) showed less equality. The decomposition of Thiel L index implicated the inequalities within the divisions, which contributed about 85% to the total Theil L index. The eastern division's Theil L index was the highest of the divisions. Conclusions: Chinese village physician distribution is generally equitable. But there are obvious inequalities existing with the divisions. To achieve a more equitable distribution of health workforce in rural China, the cultivation and retention of village physicians needs to keep pace with the increase in health service demand among rural residents. In addition, government should pay more attention to the inequality in village physician distribution between different regions, as well as within a region.