Background
According to relevant documents released by the China National Health and Family Planning Commission, the term “high-technology medical equipment” (HTME) refers to high-technology, large-scale, precise and valuable instruments Many HTME are used in a health care setting for diagnosis. Undoubtedly, HTME are important health resources, playing a prominent role in enhancing the health care quality and the accuracy of diagnoses [
1‐
3].
Assessing equity in the distribution of HTME in Guangxi is of utmost significance for several reasons. On the one hand, there is huge gap in socio-economic development in Guangxi. Three major cities, namely, Nanning, Guilin, and Liuzhou, have more health resources, the competition among hospitals may worsen the allocation equity of HTME. On the other hand, availability of HTME plays a vital role in improving health system’s performance. However, there is unequal distribution of these equipment in favor of metropolis and well equipped health facilities, which affects the availability and the equity of HTME significantly. This study sought to examine the equity gaps in the distribution of HTME in Guangxi using concentration index. The results of this study could shed light on the future HTME allocation in Guangxi.
Though published research has reported on the inequity of health care resources allocation [
4‐
8], only a small number of researches have focused on the equity status of HTME. For example, two studies show that CT and MRI in China based on population distribution is relatively fair while it’ s less fair based on geographical distribution [
9,
10]. According to a study on the equity status of HTME in Guangxi, the Gini coefficients of CT, MRI, DSA, LA, and SPECT were smaller than 0.40, which indicated a relatively equitable allocation [
11]. A study on the equity status of HTME in a province showed that the Gini coefficients of LA, DSA, SPECT were higher than 0.40, which indicated that the equity of these three equipment was in alerting status [
12]. A study found that the equity status of the new models of CT, MRI, and PET got improve in Japan, while the old models got worse [
13].
Guangxi Zhuang Autonomous Region is one of the five ethnic minority regions in China, and it is located in southwestern China and borders Guangdong Province, Hunan Province, Guizhou Province and Yunnan Province. Guangxi includes 14 prefecture-level cities and 8 county-level jurisdictions. Aside from the majority Han population, Guangxi has more recognized ethnic minority groups than any other region in China, including Zhuang, Yao, Miao and Dong, which accounts for 37% of its population [
14,
15].
Discussion
From the absolute number point of view, the quantity of CT, MRI, LA in Guangxi is inferior to Hunan Province (372 CT, 103 MRI, 66 DSA, 63 LA, and 19 SPECT) in central China while it exceeds that of Hunan for DSA and SPECT. Furthermore, the total number of HTME in Guangxi exceeds the number in Xinjiang Uyghur Autonomous Region (218 HTME) in Western China. The possession of SPECT per million population in Guangxi is lower than the national average level while it is superior to the national average level for CT, DSA, MRI and LA. The possession of CT and MRI per million population in Guangxi is inferior to that of Shanghai (7.60 CT per million population, 3.23 MRI per million population), a developed independent municipality in Eastern China.
Overall, the concentration indices for CT, MRI, DSA, LA, and SPECT increased with growth rates of 17.35, 123.69, 3.80, 3.20, and 10.71% respectively from 2011 to 2015, which indicates that the equity status of the five medical equipment worsened. This may be partially due to the fact that those equipment are more concentrated in Nanning, Guilin, and Liuzhou, where rates increased from 43.7% in 2011 to 45.1% in 2015.
In 2015, the ranking of the equity status from the best to the worst was CT, SPECT, LA, DSA, and MRI. The distribution of CT was the fairest, which was consistent with the findings of Zhu [
11] and He [
9,
12]. CT was introduced into China early and has become commonly used in the examination of many diseases in hospitals in both underdeveloped and developed areas, thus the distribution of CT was fairest [
10]. Conversely, the distribution of MRI was the most unfair. For the differences in economics, hospitals in economically underdeveloped areas are not able to afford MRI, and since 50.5% of all MRI are concentrated in three major cities, namely Nanning, Guilin, and Liuzhou, the distribution of MRI was the least fair.
Based on our analysis, we put forward the following advice to improve the overall equity of HTME allocation. First, the Department of Health should formulate and implement regional health planning of HTME, and implement severe penalties for any hospital that fails to follow its guidelines [
28]. In addition, the Department of Health should increase financial support to the areas that have a relatively lower number of HTME per million population to improve the accessibility and equity of health services. In the meanwhile, it is necessary for the Department of Health to control the number of HTME in some cities that have a relatively higher number of HTME per million population, and to pay more attention to the equity status of MRI. Second, medical institutions at various levels should abide by the regulations released by the Department of Health. According to the actual situation of the medical institutions and the needs of local residents, medical institutions at various levels should allocate HTME rationally. Third, hospitals should set up regional image diagnosis and treatment centers and explore mechanisms for sharing HTME in order to improve their utilization and efficiency [
29,
30].
Conclusion
Inequity in the distribution of HTME still exists in Guangxi. Overall, the equity status in the distribution of the five medical equipment has deteriorated since 2011. To reduce the inequity of HTME in Guangxi, stakeholders, including policymakers, hospitals, and patients, should strive to cooperate jointly in order to ameliorate the situation.
Acknowledgements
Not applicable.