The Lancet, Volume 372, Issue 9651
, Pages 1774 - 1781, 15 November 2008
doi:10.1016/S0140-6736(08)61363-XCite or Link Using DOI
This article can be found in the following collections: Public Health; Global Health
Copyright © 2008 Elsevier Ltd All rights reserved.
China's human resources for health: quantity, quality, and distribution
In this paper, we analyse China's current health workforce in terms of quantity, quality, and distribution. Unlike most countries, China has more doctors than nurses—in 2005, there were 1·9 million licensed doctors and 1·4 million nurses. Doctor density in urban areas was more than twice that in rural areas, with nurse density showing more than a three-fold difference. Most of China's doctors (67·2%) and nurses (97·5%) have been educated up to only junior college or secondary school level. Since 1998 there has been a massive expansion of medical education, with an excess in the production of health workers over absorption into the health workforce. Inter-county inequality in the distribution of both doctors and nurses is very high, with most of this inequality accounted for by within-province inequalities (82% or more) rather than by between-province inequalities. Urban—rural disparities in doctor and nurse density account for about a third of overall inter-county inequality. These inequalities matter greatly with respect to health outcomes across counties, provinces, and strata in China; for instance, a cross-county multiple regression analysis using data from the 2000 census shows that the density of health workers is highly significant in explaining infant mortality.
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a Department of Economics, University of Oxford, Oxford, UK b Global Equity Initiative, Harvard University, Cambridge, MA, USA c Health Human Resources Development Centre, Beijing, China d Harvard School of Public Health, Boston, USA e Peking University Health Science Centre (PUHSC), Beijing, China f China Medical Board, Cambridge, MA, USA Correspondence to: Prof Sudhir Anand, St Catherine's College, Oxford OX1 3UJ, UK
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