China's human resources for health: quantity, quality, and distribution

Lancet. 2008 Nov 15;372(9651):1774-81. doi: 10.1016/S0140-6736(08)61363-X. Epub 2008 Oct 17.


In this paper, we analyse China's current health workforce in terms of quantity, quality, and distribution. Unlike most countries, China has more doctors than nurses-in 2005, there were 1.9 million licensed doctors and 1.4 million nurses. Doctor density in urban areas was more than twice that in rural areas, with nurse density showing more than a three-fold difference. Most of China's doctors (67.2%) and nurses (97.5%) have been educated up to only junior college or secondary school level. Since 1998 there has been a massive expansion of medical education, with an excess in the production of health workers over absorption into the health workforce. Inter-county inequality in the distribution of both doctors and nurses is very high, with most of this inequality accounted for by within-province inequalities (82% or more) rather than by between-province inequalities. Urban-rural disparities in doctor and nurse density account for about a third of overall inter-county inequality. These inequalities matter greatly with respect to health outcomes across counties, provinces, and strata in China; for instance, a cross-county multiple regression analysis using data from the 2000 census shows that the density of health workers is highly significant in explaining infant mortality.

MeSH terms

  • China
  • Educational Status
  • Female
  • Health Care Reform*
  • Health Personnel / education
  • Health Personnel / statistics & numerical data*
  • Health Workforce / statistics & numerical data*
  • Healthcare Disparities / economics
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Male
  • Rural Health Services / statistics & numerical data*
  • Rural Health Services / supply & distribution
  • Urban Health Services / statistics & numerical data*
  • Urban Health Services / supply & distribution