Human resources for health is defined as the sum and quality of health workers with certain professional skills in health industry during a certain time in a certain region, it is the key to maintaining and strengthening the function of health systems and is an important indicator to measure the level of health services (Chen Xiao-ming, 2012). Health human resources is a main carrier of medical and health services, therefore, its reasonable allocation is essential to ensure residents’ fair benefits and rights for health care and to promote equity in healthcare industry (Xu Min-xuan & Jia Li-ying, 2018). Chongqing is the only municipality under the direct leadership of central government in western China, an important strategic fulcrum of the Silk Road and the main force for the construction of the Southwest, so analysis on the current situation of health human resources and the equity here has great significance. The approaches used in the previous studies of the equity of health human resources so far mostly concentrate on Gini coefficient, Lorenz curve, etc., which are single-dimension indexes with uncertainty and incompleteness (Liu Xiao-li, Xu Xiao-lan, & Zhou Le-ming, 2017). Therefore, under the condition of Chongqing health human resources allocation, this research comprehensively analyzed fairness with the use of the agglomeration degree of health human resources based on population and area size, compared the differences of health human resources between different regions, and put forward suggestions based on existing issues in order to provide reference for the development of scientific health strategies.
2. Data and Methods
The data about health technicians were come from the official website of Chongqing Municipal Commission of Health, The data about practicing physicians and registered nurses were collected from the statistical yearbook. The data about population and area size were compiled from the Chongqing Statistical Yearbook.
Population agglomeration degree (PAD) is defined as the proportion of the population (%) in an area that accounts for 1% of the total area size, which reflects the degree of population agglomeration relative to the total population (Yuan Su-wei, Wei Feng-qing, & Liu Wen-wei, 2015).
Pi denotes the population of a certain area; Ai denotes a certain area size; Pn denotes the total population; An denotes the total area size.
Health human resources agglomeration degree (HRAD) is defined as the proportion of human health resources in a region that accounts for 1% of the total area size (%), which reflects the concentration of health human resources in a region relative to the total health human resources (Wang Wei, Li Yuan-ju, & Ma Lu-ye, 2017).
HRi indicates the amount of human health resources in a certain area, Ai indicates a certain area size, HRn indicates the total health human resources, and An indicates the total area size.
When using the agglomeration degree to evaluate the allocation of health human resources, it is generally believed that the more the HRAD approaches 1, the fairer the allocation of health human resources by area size is, and the HRAD above 1 indicates the region’s health human resources is redundant (Cheng Lihui, Bai Ya-mei, & Song Yu-lei, 2018). When the HRAD/PAD = 1, that is, the ratio of the proportion of health human resources in an area that accounts for 1% of the total area size to the proportion of the population in the same area is equal to, meaning the allocation of health human resources by population is in a state of absolute equity; when HRAD/PAD > 1, indicating the health human resources are redundant for the population in that area; when HRAD/PAD < 0, indicating the health human resources are insufficient in that area (Hu Hui-mei, Chen Ding-wan, & Gao Qi-sheng, 2016).
3.1. Status of Health Human Resources Allocation in Chongqing
Chongqing covers an area of 82,400 square kilometers and has 38 administrative districts. It is divided into four parts: main urban area, the west, the northeast, and the southeast (Figure 1). The main urban area includes Yuzhong, Dadukou, Jiangbei, Shapingba, Jiulongpo, Nan’an, Beibei, Yubei, Banan Districts; the west includes Fuling, Changshou, Jiangjin, Hechuan, Yongchuan, Nanchuan, Yongjiang, Dazu, Laoshan, Tongliang, Tongnan, and Rongchang Districts; the northeast of Chongqing includes Wanzhou, Kaizhou, Liangping, Chengkou, Fengdu, Dianjiang, Zhongshan, Yunyang, Fengjie, Wushan, and Wuxi Districts; the southeast includes Qianjiang, Wulong, Shizhu, Xiushan, Youyang, and Pengshui Districts (Chongqing Statistics Bureau, 2018).
By the end of 2018, there were 200,396 health technicians, 78,361 practicing physicians, and 95,104 registered nurses in Chongqing, accounting for 2.13%, 2.02%, and 2.23% nationwide, respectively, and the doctor to nurse ratio was 1: 1.22. There were 6.22 health technicians, 2.22 practicing physicians, 2.76 registered nurses per 1000 residents; 2.35 health technicians, 0.83 practicing physicians, 1.03 registered nurses per square kilometer. From 2014 to 2018, the total health human resources in Chongqing showed an increasing trend. The number of registered nurses increased most significantly, with an average annual growth rate of 11.95%. The growth rates of health technicians and practicing physicians were 6.84 %, 7.74%, respectively, which are relatively small (Table 1).
Figure 1. The map of Chongqing area distribution.
Table 1. Chongqing human resources for health 2014-2018.
3.2. Results of Health Human Resources in Different Districts of Chongqing in 2018
3.2.1. Analysis of the Agglomeration of Health Human Resources Based on Area Size
According to Table 2, it could be seen that the HRAD values of Yuzhong, Dadukou, Jiangbei, Shapingba, Jiulongpo, Nan’an, Beibei, Yubei, Banan, Changshou, Hechuan, Hechuan, Yongchuan, Laoshan, Tongliang, Rongchang and Wanzhou Districts were greater than 1, indicating that the health human resources in these districts were redundant. The HRAD values of Jiangjin, Nanchuan, Dazu, Taonan, Kaizhou, Chengkou, Fengdu, Zhong, Yunyang, Fengjie, Wuxi, Qianjiang, Wulong, Shizhu, Xiushan, Youyang and Pengshui Districts were all smaller than 1, showing that the health human resources in those areas were relatively insufficient in terms of their area size.
3.2.2. Analysis of the Agglomeration of Health Human Resources Based on Local Population
There were significant differences in the results of HRAD/PAD in different districts of Chongqing. In terms of the allocation of health technicians, the HRAD/PAD values of Yuzhong, Dadukou, Jiangbei, Shapingba and Jiulongpo Districts were much higher than 1, indicating that the health technicians in these areas was relatively redundant for local population, while the health human resources in Chengkou, Youyang, Wulong and Pengshui Districts were relatively inadequate. In terms of the allocation of practicing physicians, the HRAD/PAD values of Beibei and Bishan Districts were 1.007 and 0.991, which were the closest to 1, indicating that the allocations of practicing physicians in both districts were most equitable for local population. In terms of the allocation of registered nurses, the HRAD/PAD value of Yuzhong District was the highest, showing that the allocation of registered nurses was extremely redundant for the local population. The HRAD/PAD value of Wuxi District was the lowest, meaning that the allocation of registered nurses in this area was seriously insufficient (Table 2).
Table 2. Evaluation results of health human resources in 2018.
3.3. Analysis of the Agglomeration Degree of Health Human Resources in Chongqing from 2014 to 2018
3.3.1. Trend of the Agglomeration Degree of Health Human Resources in Different Districts Based on Area Size
From 2014 to 2018, the HRAD values of health technicians and practicing physicians in the main urban area were greater than 1, while the values in the northeast and southeast of Chongqing were far less than 1, with a downward trend in fluctuation; the value of the western area was around 1, meaning the allocation of health human resources in the west were the most equitable. The values for registered nurses in main urban area have been rising year by year, but declined slightly in 2016; the values of registered nurses in Northeast and Southeast of Chongqing decreased in 2018, in comparison with those in 2013, meaning the equity of the allocation of registered nurses needs to be improved in terms of the area size (see Table 3 for details).
3.3.2. Trend of the Agglomeration Degree of Health Human Resources in Different Regions Based on Population
As shown in Figures 2-5, the values of HRAD/PAD of the three indicators in the main urban area from 2014 to 2018 were much greater than 1, representing that the health human resources for the population in the area was redundant, but a slight downward trend was observed since 2015, meaning the situation is being improved. The values of HRAD/PAD of the three indicators in the west and
Table 3. Agglomeration of health human resources of the four major districts in Chongqing.
Figure 2. Ratio of health human resources agglomeration to population agglomeration in the main urban area.
Figure 3. Ratio of health human resources agglomeration to population agglomeration in the east.
Figure 4. Ratio of health human resources agglomeration to population agglomeration in the northeast.
Figure 5. Ratio of health human resources agglomeration to population agglomeration in the southeast.
northeast of Chongqing were smaller than 1, and they have been continued to decline in the past five years, showing the allocation of health human resources for the population in these areas are poor, with serious shortage in health human resources. Although the value of the three indicators was smaller than 1, it kept growing in the past five years, meaning the equity of health human resources allocation has been gradually optimized.
4. Discussion and Suggestions
4.1. The Human Resources for Health Has Increased, but the Total Resources Are Still Insufficient
With the development of the economy, Chongqing’s medical system has been continuously improved, and health resources in all aspects have also increased to a certain extent. However, the allocation of health human resources is still insufficient and the resources per capita are relatively scanty. The number of health technicians, practicing physicians, and registered nurses per thousand people in Chongqing are lower than the national average, much lower than in Beijing, Tianjin, and Shanghai. As mentioned in Planning of Medical and Health System in Chongqing (2015-2020), the number of practicing physicians is 2.57 per 1000 people, and the number of registered nurses is 3.21 per 1000 people in Chongqing by 2020, which shows a certain gap in the allocation of health human resources, a gap that is prominent particularly in the Northeast and Southeast of Chongqing. To solve these problems, on the one hand, policies for medical education must be made to ensure the quality and quantity of medical workers, given that medical education is the major source for cultivating medical workers. It is recommended that government formulate long-term training plans for health personnel and policies such as setting up scholarships and designing free and orientated training plans so as to attract more students into medical industry, involving outstanding students from the very beginning; On the other hand, it is recommended that the medical department improve the salary and working environment for medical workers so as to reduce staff turnover. These measures can continuously expand the medical group by increasing staff retention and decreasing staff turnover.
4.2. Significant Differences Existed in the Equity of Health Human Resources in Different Areas
The health human resources are seriously insufficient in underdeveloped areas including Wuxi, Youyang and Wulong Districts, due to lagged economic development and inadequate investment from governments. However, Yuzhong district, which takes up only 0.29% of the Chongqing’s total area and 2.14% of the total population, is equipped with health human resources accounting for 9.89% of the total districts. This shows that Chongqing’s human resources for health are excessively concentrated in the developed central areas, but are insufficient in remote and underdeveloped areas, with problems such as waste of resources and inadequacy. This result is basically consistent with the research conclusions of (Fu Xian-zhi, Lu Feng, & Cao Yun-yuan, 2017) and (Liu Li, 2012). Differences among regions are the main reason that causes inequity of health human resources. Therefore, authorities in the underdeveloped regions should make policies to attract more medical workers as they develop the economy, and the governments in urban central districts should strengthen cooperation and coordination with the underdeveloped regions, and assist in improving the status of health human resources in these areas with the use of their own resources. In addition, according to an relative study by (Zhou Di & Yuan Jie-song, 2018), the current health human resources are still not equitable enough, thus government at all levels should adjust and optimize the structure of health human resources allocation and improve the policies in fairness and guidance, so as to realize equitable and reasonable allocation of health human resources and narrow the gap between districts and regions.
4.3. The Equity of Health Human Resources Varies in Different Areas
According to the analysis of HRAD/PAD from 2014 to 2018, different development trends are shown in different regions. The redundant allocations of health human resources in main urban areas have gradually improved, as well as the equity of allocation in the southeast of Chongqing. However, the equity in the west and northeast has declined year by year. To conclude, the general equity of health human resources in Chongqing has not been effectively improved. In order to meet needs of residents in different regions for health human resources, a system based on local conditions for the development of health human resources should be built in some regions, standards of the allocation should be made, and a layout for the composition and the number of medical workers should be determined. If the region has a large population, then this factor should be considered in the allocation of health human resources. If the region has a relatively small population, the needs and geographical factors should be paid attention to, so as to ensure the equity and accessibility of the allocation plan of health human resources.
In all, there is insufficient total health resource allocation in Chongqing, there are significant differences in the equity of health human resources in various regions, and the equity of health human resources in different regions is developing differently. It is suggested to increase the training of medical students in schools, cooperation in hospitals, and government planning to optimize the allocation of human resources in Chongqing.
There are still some limitations in this article. In terms of data, only the Chongqing region resources were analyzed vertically from 2014 to 2017, it was not compared with the data of other provinces in China or even other countries around the world. In terms of methods, this article only uses one method to evaluate fairness, depend on the existing essay, there are other methods that focusing on how to make better analyses. In future research, we will try our best to improve the above problems.