The Inequity of Eye Care Resources Allocation from 2013 to 2019 in Shanghai, China

As the eye disease burden is increasing, the allocation of eye care resources plays an important role in the sustainable development of eye care services. This study is to investigate the allocation and trend of eye care resources from 2013 to 2019 in Shanghai, China.

This study was composed of multiple cross-sectional surveys conducted in 2013, 2015, 2017, and 2019, in Shanghai, China. Institutions, doctors, technicians, and nurses were selected for describing eye care resources. The Lorenz curve, Gini coefficient, and Theil index were applied to assess the equity of eye care resource allocation. Trend analyses were applied to assess the temporal change.

From 2013 to 2019, the total of eye care institutions increased a few, from 319 to 333, and the number of doctors and technicians almost doubled, but the number of nurses remained around 900. Institutions, doctors, technicians, and nurses were all concentrated heavily in the urban regions of Shanghai and the suburban regions have the lower density of institutions (ranging from 0.25 to 0.73 per 10,000 persons) and doctors (ranging from 1.35 to 2.01 per 10,000 persons). The contributions of total inequity for each indicator are different. For institutions and doctors, the major variations were from the differences between urban and suburban regions (more than 50%). For technicians, the inter-variation between urban and suburban regions contributed nearly 40% of the total inequity. But for nurses, the intra-variations in urban and suburban districts contributed to the major inequity (almost 80%). Given the temporal change of the Theil index, the inter-variations between urban and suburban regions among doctors decreased from 67.4% to 50.0% (P for trend 0.023), and the intra-variations in suburban districts among technicians also decreased from 35.0% to 27.3% (P for trend 0.022). GDP per capita and subway density were both associated with the allocation of eye care resoureces in Shanghai.

The eye care resources were continuously more concentrated in the urban regions in Shanghai. The number of ophthalmologists in Shanghai is sufficient, but there is a shortage of auxiliary technicians and nurses. Future health policies should pay more attention to balancing the allocation of eye care resources and increasing the number of auxiliary technicians and nurses.