Medical specialty distribution in China, 2009–17: a longitudinal examination. Issue 1 (October 2019)

• Record Type: Journal Article
• Authors: Fan, Angela P; Kosik, Russell O; Fan, Lihong; Zhao, Xudong; Hsu, Yunung; Lien, Selina S; Li, Dan; Ren, Yuanpeng; Jiang, Baisheng; Chen, Qi
• Is Part Of: Lancet. Volume 394(2019)Special Issue 1
• Page Start: S64
• Publication Date: 2019-10
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(19)32400-6
• Languages: English
• ISSNs: 0140-6736

Abstract

Abstract: Background: China's practitioners are responsible for serving the most populous country in the world. Despite the pronounced shortages of areas, such as general practice and paediatrics, little is known about the discrepancies between supply and demand in each specialty. We aimed to examine China's supply of and demand for health care since 2009 to gain an understanding of the progress that reforms have brought about. Methods: We analysed distribution data regarding licensed medical practitioners and patient visits for all clinical departments between 2009 and 2017 using annual reports and yearbooks provided by the Chinese National Health and Family Planning Commission, which are published by the government of China and the Peking Union Medical College. The institutional review board of the principal investigator's institution approved this study. Findings: From 2009 to 2017, the number of registered practicing physicians increased by 48·5%. Inpatient hospitalisations increased by 98·2%, and outpatient visits increased by 69·4%. Internal medicine had a 64·5% inpatient demand–supply gap in growth rate (DSG) and a 6·5% outpatient DSG. For all specialties, negative inpatient DSGs were found in general practice (–36·8%), preventive medicine (–30·5%), stomatology (–12·1%), and aesthetic medicine (–11·9%); negative outpatient DSG was only found in stomatology (–7·6%). General practice has −41·3% outpatient DSG at the hospital level, suggesting patients in need of general practice might no longer go to hospitals, instead favouring more convenient primary care near home. Interpretation: A major goal of China's 2009 reforms was to improve the quality of service during primary care visits. Although between 2009 and 2017 most of the departments' growth rates in physician quantity were slower than those of the patients', China's efforts to train more general practices at primary care institutions over this period has so far been an effective means of promoting equal access to health care. Funding: Republic of China Ministry of Science and Technology (MOST 105-2629-S-010-001).