The misdistribution of health manpower is one of the major
challenges faced by the Chinese health sector hindering people's
access to healthcare. However, this subject remains underexplored,
as spatial distribution characteristics have not been fully mapped
out, nor have its causes been determined at the macro regional
level. To fill this research void, this study aims to conduct
sophisticated spatial analyses to examine the characteristics of
health manpower distribution and test various determinants of
health manpower densities. By introducing spatial techniques, this
study sheds light on the distribution of health manpower in China,
thus offering invaluable evidence for making national and regional
policies to facilitate a more effective distribution of health
manpower in China. On the one hand, this study used spatial
statistics (space-time scan statistics and Moran's I statistics) to
reveal, visualize, and compare the temporal trends, spatio-temporal
dynamics, and spatial clustering patterns of different subtypes of
health manpower (clinicians, doctors of traditional Chinese
medicine, dentists, public health doctors, general practitioners,
registered nurses, pharmacists, technologists, and interns) and
their total. The results reveal that regional disparities and huge
urban-rural imbalances exist in China's health manpower
distribution, indicating that some provincial units have been left
behind. In addition, spatial distribution characteristics varied
across different subtypes of health manpower, which still held with
respect to either the urban or rural health manpower distribution.
On the other hand, this study theoretically modeled and empirically
measured various determinants of health manpower distribution from
both the supply and demand sides while taking the spillover effect
between adjacent geographical units into consideration. Based on
the results of the estimation, the health service demand was, as
expected, found to forcefully drive the health manpower
distribution across the nation. In light of this, the increase in
health services demands in a province could significantly help one
unit attract licensed doctors and registered nurses from adjacent
units. Unexpectedly but intriguingly, the power of medical
education capacity was relatively limited in increasing the health
manpower density in local units compared to its spillover effect on
neighboring units. In addition, government and social health
expenditure played different roles in the health labor market, the
former being more effective in increasing the stock of licensed
doctors and registered nurses, the latter doing better in
attracting dentists and general practitioners. This study has the
potential to make profound contributions to the theory and practice
of health manpower distribution in China. First, this study
advances our understanding of characteristics of health manpower
distribution by introducing spatial statistics. By doing so, this
study visualizes the detailed spatial distribution characteristics
with maps and identifies the priority areas for health manpower
allocation in China. Second, this study provides a comprehensive
research framework to understand the potential drivers of health
manpower distribution, and more importantly, takes spillover
effects into consideration and measures them for the first time.
Third, this study systematically explores and compares the
distribution characteristics and determinants of different subtypes
of health manpower, which differ greatly. By exploring both the
characteristics and determinants, this study gives a full picture
of the health manpower distribution and provides new evidence for
making health manpower allocation policies in China.
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