The density of doctors in China has surpassed Japan and is on par with the United States, but the UHC is only 69.9, ranking 58th in the world.
Writing | Jun Ling
Source | “Medical Community” Public Account
The global shortage of healthcare workers is daunting, according to a study published May 23, 2022 in the top journal The Lancet. As of 2019, if universal health coverage (UHC) reaches at least 80% of the population, there are still about 6.4 million doctors, 30 million nurses and midwives, and 2.9 million pharmaceutical health workers worldwide.
Combining population and corresponding health needs, the study analyzed the human resources of 18 types of health care workers in 204 countries and territories between 1990 and 2019.
Specifically, the UHC in mainland China in 2019 was only 69.9, that is, 69.9 people per 100 people had access to effective medical treatment, ranking 58th.
The highest country was Japan at 96.5. The Nordic countries Iceland (95.5), Norway (94.4) and Switzerland (93.6) are close behind.
132 countries lack doctors
Research estimates that, as of 2019, there were approximately 104 million healthcare workers worldwide.
In the past 30 years, the number of medical and health workers in the world has maintained steady growth. The number of doctors has risen from an average of 10.4 per 10,000 people to 16.7, and the number of nurses and midwives has also increased by about 1.65 times to 38.6.
Researchers believe that one indicator for UHC to reach 80 is that per 10,000 people, there are typically 20.7 doctors, 70.6 nurses and midwives, 8.2 dentists, 9.4 pharmaceutical hygiene staff .
However, the number of health workers per capita varies by dozens of times across countries. In 2019, 132 countries and territories were short of doctors, 154 were short of nurses and midwives, and another 135 were short of pharmacy health personnel.
East sub-Saharan Africa, for example, has only 2.5 doctors and 31.1 other health workers per 10,000 people. Compared with Iceland, a developed country – 42.2 and 490 per 10,000 people, respectively.
Similarly, Japan has 119.2 nurses and midwives per 10,000 people, South Korea has 52.6 per 10,000 people, and Pakistan has only 7.
It is worth mentioning that, because the UHC assessment also incorporates the quality and effectiveness of medical prevention and treatment measures, including 23 indicators of medical services. The researchers found that the number of health workers also does not fully reflect a country’s capacity for universal health coverage.
Cuba, for example, has 84.4 doctors, 104 nurses and midwives per 10,000 people, but a UHC of only 72.9. The density of nurses and midwives in Japan is comparable to that of Cuba, and the density of doctors is slightly more than 1/4, but the UHC is as high as 96.5.
The density of Chinese doctors has surpassed that of Japan,
What else is missing?
According to Chinese data released by the study, as of 2019, there were 27.2 doctors per 10,000 people in China, an increase of 2.7 times compared with 30 years ago, which is comparable to the data previously released by the National Health Commission of China At the end of 2019, the total number of doctors in my country reached 3.867 million.
If the UHC is to reach 80, the minimum threshold for the density of doctors is 20.7 per 10,000 people, while China has surpassed Japan and is on par with the United States, but the UHC is only 69.9, ranking 58th in the world .
Legend: 95% confidence interval in parentheses
Research analysis shows that “production efficiency” is also crucial to universal health coverage, and UHC is also inseparable from the distribution of health workers and the quality of talents. “Increasing the number of practitioners cannot fully compensate for the underlying problem of low ‘production efficiency’, at least not in a cost-effective way, when the number has reached the target,” the study said.
For China, on the one hand, the distribution of “quality” and “quantity” of doctors is significantly different. Statistics show that in 2018, the number of doctors per 10,000 people in rural China was 18, only 45% of that in cities.The article “Research on the Equity of the Distribution of Chinese Doctors, Nurses and Beds among Provinces” also mentioned that the function ratio of medical and health institutions in the central and western counties is relatively limited, and the problem of low service level is common.
Although some regions have seen a certain growth in the number of medical beds and medical care, the internal quality still needs to be improved. Combining the professional background of practitioners, Ma Xiaowei, director of the National Health and Medical Commission, once said that medical colleges in my country cover all educational levels from secondary school to doctoral degree, and the teaching quality varies greatly between institutions and between different educational levels.
As of 2019, only 57.4% of doctors in my country have a bachelor’s degree or above, while the United States, where the density of doctors is similar to China’s, is almost “doctors per capita”.
Furthermore, the low ratio of “nursing/medical” in China is another prominent problem, at only 1.16. Compared with the top four UHC countries in the world, Japan, Iceland, Norway, and Switzerland, their “nursing/medical” ratios are 5.1, 4.1, 5.7, and 3.9, respectively.
“Although nurses are often in contact with people when they seek medical treatment, many people do not know the extent of the shortage of nursing staff in our country.” Li Xiuhua, a member of the National Committee of the Chinese People’s Political Consultative Conference, said in an interview with the media. According to the planning goal of “Healthy China 2030”, my country currently has a shortage of nearly 2 million nurses, which is about 40% of the current number of registered nurses.
Completion of the nurse talent echelon is an integral part of improving universal health coverage. “Patient mortality is higher in hospitals with lower nurse-to-patient ratios.” Norwich University, USA Combined with literature analysis, it was pointed out:
Nurse shortages can lead to increased patient wait times for medical attention, length of hospital stay, and frequency of readmissions. At the same time, nurse burnout due to staffing shortages can also threaten patient health, potentially leading to more medical errors when nurses work longer shifts.
There are many reasons for the shortage of nurses, such as work environment, career prospects, labor intensity, nurse-patient relationship, treatment, etc. The study published in The Lancet specifically pointed out that midwives include midwives. Including, this group is the largest group of health workers in the world, and in many countries, more than 90% of nurses and midwives are women. In the case of understaffing, if they have provided sufficient and effective health care services, it often represents “unpaid labor”.
The study cites another analysis showing that female health workers’ “unpaid labor” accounts for 31%-49% of their total contribution to the health sector, “and they contribute a lot to the health sector. Labour disproportionate to treatment, gender disparities in the health workforce should be examined to empower health workers equally,” the study said.
Beyond the doctor,
Other health workers in critical shortage in our country
In addition to doctors, nurses and midwives, according to the research statistics, China is as close as the developed world in terms of the number of practitioners in 16 occupations, including pharmacy personnel, community health workers, and mental health workers. There are still large gaps between countries.
In Japan, the United Kingdom, and the United States, the total number of these 16 occupations reached 231, 300, and 274 per 10,000 people, compared to only 81 in China. Among them, pharmacy The personnel gap is nearly double the standard deviation of UHC80.
Take hospital pharmacists as an example, this group should be the first-line medication professionals, but my country has not officially issued the “Pharmacist Law” so far. “Pharmaceutical services” have only begun to emerge in recent years, and most of them are limited to tertiary hospitals in first- and second-tier cities.
In most cases, daily medication consultation, including chronic disease management, is still undertaken by limited human resources of doctors, and the availability and quality of pharmacists’ “pharmacy services” are low, further limiting The level of “universal health coverage” has been improved.
Another profession that has been emerging in developed countries in Europe and America for many years – physician assistant, has yet to take shape in China. Taking the United States as an example, the admission education standard of a doctor’s assistant is a master’s degree, who is responsible for the initial diagnosis of the patient, completes the collection of physical signs, medical history and other information, and issues an examination to determine the condition. After that, the patient will meet the doctor, and the doctor will go straight to the subject and complete the core diagnosis and treatment process. .
This profession has been proven to be an effective means of saving doctor resources in Europe and the United States, but limited by the existing medical structure, financial investment and treatment distribution and many other reasons, these jobs in my country are often The responsibility of young doctors and resident doctors has not really realized the liberation of the labor force of the doctor group.
In addition, there are also large gaps in mental health workers and professional nursing workers in my country. To improve “universal health coverage”, the study argues, countries need to enable all types of health workers to “thriving”, increasing their participation, satisfaction and creating work environments that increase their productivity.
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