Equity of health workforce distribution in Thailand: an implication of concentration index
Received 23 July 2018
Accepted for publication 12 December 2018
Published 5 February 2019 Volume 2019:12 Pages 13—22
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Kent Rondeau
Woranan Witthayapipopsakul,1 Nisachol Cetthakrikul,2 Rapeepong Suphanchaimat,3,4 Thinakorn Noree,5 Krisada Sawaengdee5
1Health Financing Node, International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand; 2Health Promotion Policy Research Centre, International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand; 3Non-Thai population research unit, International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand; 4Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand; 5Human Resources for Health Development Office, International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
Background: Geographical maldistribution has been a critical concern of health workforce planning in Thailand for years. This study aimed to assess the equity of health workforce distribution in public hospitals affiliated to the Office of Permanent Secretary (OPS) of the Ministry of Public Health (MOPH) through the application of “concentration index” (CI).
Methods: A cross sectional quantitative design was employed. The dataset comprised 1) health workforce data from the OPS, MOPH in 2016, 2) regional and provincial-level economic data from the National Economic and Social Development Board in 2015, and 3) population data from the Ministry of Interior in 2015. Descriptive statistics, Spearman’s rank correlation, and CI analysis were performed.
Results: Thailand had 2.04 health professionals working in public facilities per 1,000 population. Spearman’s correlation found positive relationship in all health professionals. Yet, statistical significance was not found in most health professionals but doctors (P<0.001). Positive correlation was observed in all health cadres at regional and provincial hospitals (rs=0.348, P=0.002). In the CI analysis, the distribution of health professionals across provincial income was relatively equitable in all cadres. Significant CIs were found in doctor density (CI =0.055, P=0.001), all professionals density at district hospitals (CI =–0.049, P=0.012), and all professionals density at provincial and regional hospitals (CI =0.078, P=0.003).
Conclusion: The positive CIs implied that the distribution of all health professionals, especially doctors, at provincial and regional hospitals slightly favored the richer provinces. In contrast, the distribution at district hospitals was slightly more concentrated in less well-off provinces. From a macro-view, the distribution of all health professionals in Thailand was relatively equitable across provincial economic status. This might be due to the extensive health infrastructure development and rural retention policies over the past four decades.
Keywords: equity, health workforce distribution, concentration index, concentration curve, Thailand
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