Health resources allocation analyzing of the western China

Background: To achieve the goal “health equity for all", equitable and reasonable allocation of health resources is the basic material guarantee. As an area which owns more developing provinces and minority nationality region than other regions in China, the western China should get more attention in the health resources allocation while there was not. Methods: Lorentz curve, Gini coefficient and Theil index were used to analyze the health resources allocation which including number of health institutions, number of beds, (assistant) medical practitioners, registered nurses in the western China from 2014 to 2018 from two dimension: population and geography. Results: The total health resources shows an increasing tendency from 2014-2018; The Gini coefficients for health resources by population dimension were ranged from 0.057 to 0.13, in geography dimension the Gini coefficients ranged between 0.61 and 0.64. Meanwhile, the Lorentz curve in population dimension had a smaller curvature than in geography dimension; In two dimensions, the intra-group contribution rate of the Theil index was higher than the inter-group. Conclusion： The equity of health resources allocation should be further improved, especially the allocation of health institutions. Moreover, the access to health resources should also by improve by a diversity method.


Introduction
The "Healthy China 2030" Plan which released in 2016 was clearly 3 emphasized that "Gradually reduce the differences in basic health services and health levels between urban and rural areas, regions and populations to achieve universal health coverage and promote social equity" [1].To achieve this goal, what is the most significant is optimizing the allocation of health resources and ensure the fair distribution of resources [2].According to the previous research, as a developing region, the equity of the allocation of health resources in the western China was lower than that in other developed regions [3], which requires more attention but still as shortage. Hence, a research which focus on the equity of the allocation of health resources in the western China seems particularly necessary, and it had also become one of a research hot pot in the recent years.
Base on the background above, in this paper, by using the Gini coefficient, Lorentz curve and Theil index, we analyzed the equity of health resource allocation in the western China, to further promote the equity of health resource allocation, some suggestions were put forward according to the analysis results at the end.

Functional regional division
According to NDRC, the western of China includes 12  Autonomous Region, the rest of the provinces were divided into nonminority areas.

Data sources and statistical analysis
The data in this paper were mainly searched from China statistical yearbook from 2015 to 2019, and the public data which released by the National Health and Family Planning Commission from 2015 to 2019.
During searching data what we mainly focused on was the number of beds, heath institutions, (assistant) medical practitioners, registered nurses in the western of China from 2014-2018. After searching data, we established a database by using excel2010 to further process data.

Lorentz curve
Lorenz curve is one of the mainly tools to evaluate the equity of resources 5 or income distribution by income or resources classified according to different groups or regions, after that, coordinate system is constructed with the accumulated percentage of population or land area and the accumulated percentage of various medical resources. Then, draw the coordinate point connected to the zero point and each curve. The fairness is judged according to its distance from the absolute fairness line. The closer it is to the absolute fairness line, the fairer it is, and the worse it is [4].

Gini coefficient
Lorentz curve can evaluate the equity of resources. However, it cannot quantify the specific differences of equity [5], hence, the Gini coefficient is often used to fill this gap. The Gini coefficient is calculated as follows: Where, G stands for Gini coefficient, N for group number, μ for resident income, Yi and Yj for per capita income of group I and J [6].
According to the researches by Zhang nan, Peng rong et al，The Gini coefficient value range is [0,1].The closer it gets to 0, the fairer it is. On the other hand, the closer it is to 1, the less fair it is. It is generally believed that: Gini coefficient less than 0.3 means the resources allocation is in a best fair state;0.3~0.4 is the normal state; A level of alert above 0.4; Above 6 0.6 is in a dangerous state of high unfairness [7,8].

Theil index
Theil index is the major tool to measure fairness, and its value range is [0,1]. The smaller the value is, the better its fairness is. Its calculation formula is: Where, refers to the proportion of the population of each province in the total population; is the proportion of the population of each region in the total population; Each is the proportion of resources of each province in the total number of resources on this dimension.
shows the proportion of resources of each region in the total number of resources [9,10] Results

The basic situation of health resources allocation in the western China from 2014 to 2018
According to table 1 to Table 3, the distribution of health resources in 12 According to the results above we can draw a conclusion that the distribution of beds based on population dimension was most equitable, 9 the improvement effect of the equity of registered nurses was the most obvious, and the inequality of the distribution of health resources based on geographical dimension tends to worsen.

Theil index of health resources in western China
Base on the Thiel index analysis of different dimensions that shown in Table 5 and 6, the total Thiel index of health resources in the two dimensions presented tendency of Tpopulation>Tgeographical.. Moreover, the Theil index in the two dimensions shows a status of intra-group higher than inter-group. This result implied that the distribution of health resources was more equitable in the population dimension than in the geographical dimension, and the inter-group also had a higher equity of health resources allocation than the inter group.

Thiel index contribution rate analysis
From the perspective of population dimension, beds, health institutions, medical (assistant) practitioners and nurses were all showed that the intra-group contribution rate greater than the inter-group contribution rate. Among them, the contribution rate of both health institutions and registered nurses in the group reached more than 90% (Table 7).
Meanwhile, contribution rate of licensed (assistant) physicians was kept rise, and the contribution rate of beds present a decline tendency. The above results indicated that the inequity of health resource allocation based on population and geographical dimension was mainly came from intra-groups (Table 8). In the population dimension, and health institutions and registered nurses existed the most obvious intra-groups inequity distribution. Moreover, the intra-groups inequity distribution of medical (assistant) practitioners showed an increase tendency, while it was decreased in beds distribution.

Discussion
The overall health resources showed an increasing trend, while the equity improvement was not obvious except for registered nurses  [12,13].

The fairness difference mainly comes from the intra-group
According to the analysis of Theil index contribution rate in the two dimensions, the intra-group contribution rate was all over 60%, higher than the inter-group, which proved that the unfair difference in distribution mainly comes from within regions, which is consistent with the research results of Chang Xiang and Sun et al [14,15].

Strengthen government functions in the allocation of health resources to further promote fairness
Low equity and low efficiency of health resource allocation can affect the health equity of residents [16]. To promote the equity of health resources, we need to rely not only on the market, but also on the overall arrangement of the government. Therefore, the government should strengthen its functions in the allocation of health resources, to improve the equity in the allocation of health resources in the underdeveloped areas in western China, and further realize the goal of "health equity for all" which emphasized in the "13th Five-Year Plan" and the "Outline of 13 healthy China 2030 Plan".

Strengthen the distribution equity in health institutions
Health institutions play a significant role in ensuring the health of the population. Hence, a high equity of health institutions allocation is quite necessary which require the government to pay more attention to the fairness of the distribution of health institutions and improve the service capacity of health institutions to lay a solid foundation for the improvement of residents' health.

Increase access to health resources by using a diversity of tools
The equity of geographical distribution of health resources will affect the accessibility of health resources, thus affecting the health equity of residents [17]. Since the distribution of health resources in geographical dimension was not that satisfied based on the analysis results above, the government needs to strengthen the equity of health resources based on geographic through tiered medical services, medical treatment alliance, strengthen economic investment, Internet hospital and other diversity methods to improve the accessibility of health resources [18][19][20].

Conclusion
Base on the research above, we found that the major differences in