Can equitable distribution of health resources reduce under-five mortality rate? A cross-sectional study with multilevel analysis of rural counties in China

Abstract

Background

In addition to the quantity of health resources, the equitable allocation of health resources may be another factor that improves the overall health outcomes within a population. The under-five mortality rate (U5MR) is a crucial indicator that reflects the health status of a population. We aimed to explore the association between inequality of health resource distribution and U5MR in rural China.

Methods

Data were collected from routine reports compiled by each county of rural China and were obtained from the National Health Commission and Bureau of Statistics. The reports are from 1946 county-level administrative units based in all 31 provinces of rural China in 2014. We used multilevel analysis to examine the association between the U5MR and the inequality of health resource distribution, after controlling for quantity of health resources as well as social, economic, and demographic county-level variables. The Theil index was used to measure the inequality of health resource distribution at the province level.

Findings

We found that inequality of health resource distribution was significantly associated with higher U5MR, while the quantity of health resources had a statistically insignificant inverse association with U5MR. Specifically, U5MRs were higher by 70·91 and 120·52 per 1000 livebirths in each county, as the province-level Theil indices of health professionals and hospital beds increased by one unit, respectively (p=0·002 and p<0·0001, respectively). Higher gross domestic product per capita and urbanization were significantly associated with lower U5MR, and there was also an association between education level and U5MR, although this was not statistically significant.

Interpretation

In addition to the quantity of health resources, the equitable distribution of health resources might be an important determinant of U5MR in resource-poor counties. These results provide a good starting point from which to study the effect of the inequalities in health systems on health outcomes.

Funding

SS was supported by the China Scholarship Council for 1 year of study at Harvard University.