Equity and trends in general practitioners’ allocation in China: Based on ten years of data from 2012-2021

Abstract Background General practitioners (GP) are the gatekeepers of residents' health, and 2021 is the 10th year of the establishment of the GP system in China. This study aims to assess the equity and trends of GP allocation in China from 2012–2021, summarize the efforts and progress of GPs in China during the decade, and predict the development trend of GPs in mainland China in the next five years to provide a reference for regional health planning and rational allocation of GPs in China. Methods Data from 2012 to 2021 on GPs in 22 provinces, 5 autonomous regions, and 4 municipalities directly under the central government in mainland China (excluding Hong Kong, Macao, and Taiwan) are collected by us. Gini coefficient, Lorenz curve and health resource agglomeration degree (HRAD) were used to analyze the equity of the allocation of GPs in China from different dimensions, and a Grey forecasting model was used to forecast the number of GPs in 2022–2026. Results The number of GPs in mainland China increased from 109,794 to 434,868 from 2012–2021, with 3.08 GPs per 10,000 people. The Gini coefficient of GPs allocation by population in China decreased from 0.312 to 0.147 from 2012–2021, while the Gini coefficient of geographic dimension remained between 0.7 ~ 0.75. Compared with the degree of curvature of the Lorentz curve in the geographic dimension, the degree of curvature of the population and economic dimension were smaller. In 2021, the HRAD in the Eastern region was 4.618, and the Central region was 1.493, with different degrees of imbalance among regions, and the HRAD/PAD in the Eastern, Central and Western regions were 1.196, 0.880 and 0.821, respectively. GPs in the Eastern region is still concentrated, while the Central and Western regions were at a similar level, and GPs were more scarce. The Grey forecasting model predicts that the number of GPs in mainland China will reach about 720,000 in 2026, and the number of GPs per 10,000 people will reach 4.9. Conclusion After a decade of development, the number of GPs in China has increased significantly. It has reached the goal of the GP system when it was first established. However, the equity of the geographical dimension, both in terms of Gini coefficient and HRAD, has great differences between different regions, and at a low level. The Western region has the problem of insufficient GP allocation in both population and geographical dimension. In the future, the number of GPs in China will continue to grow rapidly with the support of policies. The "2030" goal, proposed in 2018, is expected to be achieved by 2026. But due to certain factors (such as COVID-19), the actual situation may be different from the predicted results.