Spatial Distribution of Health Manpower in China: Exploring its Characteristics and Determinants (Public Health in the 21st Century)

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.