Objective To analyze the distribution situation and turnover of primary health care (PHC) physicians and its impact on equity of distribution in China from 2011 to 2021, thereby providing empirical evidence for optimizing the allocation and workforce development of PHC physicians.
Methods We used the basic information of health human resources collected by the National Health Commission Statistical Information Center. Individual-level data collected by April 2022 were longitudinally linked to construct a retrospective cohort for analysis of the turnover pattern of PHC physicians. The Gini coefficient and Theil index were calculated to measure the equity of distribution. We performed counterfactual analysis to evaluate the impact of turnover on distribution equity.
Results The number of PHC physicians and the number per thousand population in China increased from 644 858 and 0.48 in 2011 to 1 102 532 and 0.78 in 2021, respectively. Among the 3 696 434 PHC physicians enrolled in the cohort study from 2011 to 2021, a total of 384 364 turnover events were related to PHC institutions, primarily occurring between PHC institutions 173 051 (45.0%). The net turnover rate of PHC physicians increased from 0.22% to 0.46% with fluctuations. The factual Gini coefficient and Theil index decreased from 0.142 and 0.033 in 2011 to 0.123 and 0.025 in 2021, respectively, while the counterfactual Gini coefficient and Theil index declined from 0.146 and 0.035 in 2012 to 0.121 and 0.024 in 2021, respectively, which suggested improved equity in the distribution of PHC physicians. From 2012 to 2021, the annual "counterfactual minus factual" results were persistently negative with absolute values ranging from 0.000 2 to 0.004 4, suggesting that physician turnover had a minimal impact on the equity of physician distribution.
Conclusions The development of PHC physicians in China shows a positive trend. Continuous efforts should be made to strengthen the dynamic monitoring and guide the rational turnover of PHC human resources.
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