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Article(id=1320442586146390052, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320442558581424898, articleNumber=null, orderNo=null, doi=10.11847/zgggws1148000, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1747670400000, receivedDateStr=2025-05-20, revisedDate=1753632000000, revisedDateStr=2025-07-28, acceptedDate=1757952000000, acceptedDateStr=2025-09-16, onlineDate=1792747645173, onlineDateStr=2026-10-23, pubDate=1770652800000, pubDateStr=2026-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792747645173, onlineIssueDateStr=2026-10-23, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792747645173, creator=13701087609, updateTime=1792747645173, updator=13701087609, issue=Issue{id=1320442558581424898, tenantId=1146029695717560320, journalId=1319373219989389464, year='2026', volume='42', issue='2', pageStart='129', pageEnd='256', issueExtLink='null', onlineDate='null', pubDate='1770652800000', pubDateStr='2026-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792747638602, creator='13701087609', updateTime=1792748118043, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1320444569574031427, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320442558581424898, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1320444569578225732, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320442558581424898, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=136, endPage=140, ext={EN=ArticleExt(id=1320442586351910949, articleId=1320442586146390052, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=An empirical study on primary health care physician turnover pattern and its impact on equity of distribution in China: a retrospective cohort analysis from 2011 to 2021, columnId=1320442559231542019, journalTitle=Chinese Journal of Public Health, columnName=Special Report—Strengthening the Public Health Workforce, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the distribution situation and turnover of primary health care (PHC) physicians and its impact on equity of distribution in China from 2011 to 2021, thereby providing empirical evidence for optimizing the allocation and workforce development of PHC physicians.

Methods

We used the basic information of health human resources collected by the National Health Commission Statistical Information Center. Individual-level data collected by April 2022 were longitudinally linked to construct a retrospective cohort for analysis of the turnover pattern of PHC physicians. The Gini coefficient and Theil index were calculated to measure the equity of distribution. We performed counterfactual analysis to evaluate the impact of turnover on distribution equity.

Results

The number of PHC physicians and the number per thousand population in China increased from 644 858 and 0.48 in 2011 to 1 102 532 and 0.78 in 2021, respectively. Among the 3 696 434 PHC physicians enrolled in the cohort study from 2011 to 2021, a total of 384 364 turnover events were related to PHC institutions, primarily occurring between PHC institutions [173 051 (45.0%)]. The net turnover rate of PHC physicians increased from 0.22% to 0.46% with fluctuations. The factual Gini coefficient and Theil index decreased from 0.142 and 0.033 in 2011 to 0.123 and 0.025 in 2021, respectively, while the counterfactual Gini coefficient and Theil index declined from 0.146 and 0.035 in 2012 to 0.121 and 0.024 in 2021, respectively, which suggested improved equity in the distribution of PHC physicians. From 2012 to 2021, the annual "counterfactual minus factual" results were persistently negative with absolute values ranging from 0.000 2 to 0.004 4, suggesting that physician turnover had a minimal impact on the equity of physician distribution.

Conclusions

The development of PHC physicians in China shows a positive trend. Continuous efforts should be made to strengthen the dynamic monitoring and guide the rational turnover of PHC human resources.

, authors=Xiaoxu WANG1, Mengmeng HU2, Yiwen MA3, Yaoguang ZHANG1, authorsList=Xiaoxu WANG, Mengmeng HU, Yiwen MA, Yaoguang ZHANG, authorCompany=null, correspAuthors=Yaoguang ZHANG, authorNote=null, correspAuthorsNote=
ZHANG Yaoguang, E-mail:
, copyrightStatement=Copyright © 2026 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1320442588054798392, articleId=1320442586146390052, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=中国基层医疗卫生机构执业医师流动特征及其配置公平性效应实证：基于2011—2021年回顾性队列分析, columnId=1320442559386731269, journalTitle=中国公共卫生, columnName=专题报道——加强公共卫生人才队伍建设, runingTitle=null, highlight=null, articleAbstract=
目的

分析2011—2021年中国基层医疗卫生机构执业医师分布现状、流动情况及其对整体配置公平性的影响，为优化基层执业医师配置和队伍建设提供实证依据。

方法

利用国家卫生健康统计职能部门采集的卫生人力基本信息调查表，将截至2022年4月采集的信息以人为单位纵向链接构建回顾性队列数据，解释中国执业医师流动特征，采用基尼系数和泰尔指数测算执业医师分布公平性系数，并通过反事实方法量化评估流动的配置公平性效应。

结果

中国基层医疗卫生机构执业医师数和每千人口执业医师数分别从2011年的644 858人和0.48人增长到2021年的1 102 532人和0.78人；2011—2021年纳入队列研究的3 696 434名执业医师中，有384 364名执业医师流动与基层医疗卫生机构有关，其中以在基层医疗卫生机构间流动为主[173 051人（45.0%）]，基层医疗卫生机构执业医师净流动率从2011年的0.22%波动性增长到2021年的0.46%；事实基尼系数和泰尔指数分别从2011年的0.142和0.033下降到2021年的0.123和0.025，反事实基尼系数和泰尔指数分别从2012年的0.146和0.035下降到2021年的0.121和0.024，基层医疗卫生机构执业医师流动配置公平性有所提升；2012—2021年各年“反事实—事实”结果均为负值且绝对值为0.000 2～0.004 4，执业医师流动对基层医疗卫生机构执业医师配置公平性影响甚微。

结论

2011—2021年中国基层医疗卫生机构执业医师发展态势较好，应继续加强人员动态监测，引导卫生人力资源合理流动。

, authors=王晓旭1, 胡萌萌2, 马艺文3, 张耀光1, *, *, authorsList=王晓旭, 胡萌萌, 马艺文, 张耀光, authorCompany=null, correspAuthors=张耀光, authorNote=

王晓旭（1993—），助理研究员，博士，研究方向：卫生人力资源

, correspAuthorsNote=
张耀光，E-mail：
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Geographical distribution of PHC physicians and the number of PHC physicians per thousand population in China, 2011–2021

, figureFileSmall=null, figureFileBig=null, tableContent=
项目2011年2012年2013年2014年2015年2016年2017年2018年2019年2020年2021年
执业医师数/人
　全国644 858668 665696 094704 759731 851764 867817 657882 282957 2511 037 4031 102 532
　东部264 890279 403301 191306 113320 130335 757364 500401 989435 515468 437496 619
　中部148 865153 749156 900162 255169 195177 884187 999197 566213 144236 988255 520
　西部171 932175 292178 165179 060183 293190 855201 559214 328238 239256 331271 527
　东北部59 17160 22159 83857 33159 23360 37163 59968 39970 35375 64778 866
每千人口执业医师数/人
　全国0.480.490.510.510.530.550.580.630.680.740.78
　东部0.510.530.570.570.590.610.660.720.780.830.88
　中部0.420.430.440.450.470.490.520.540.580.650.70
　西部0.470.480.480.480.490.510.530.560.620.670.71
　东北部0.540.560.560.540.570.580.620.680.700.770.81
), ArticleFig(id=1320442591443796070, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320442586146390052, language=CN, label=表1, caption=

中国基层医疗卫生机构2011—2021年执业医师地区分布和每千人口配置情况

, figureFileSmall=null, figureFileBig=null, tableContent=
项目2011年2012年2013年2014年2015年2016年2017年2018年2019年2020年2021年
执业医师数/人
　全国644 858668 665696 094704 759731 851764 867817 657882 282957 2511 037 4031 102 532
　东部264 890279 403301 191306 113320 130335 757364 500401 989435 515468 437496 619
　中部148 865153 749156 900162 255169 195177 884187 999197 566213 144236 988255 520
　西部171 932175 292178 165179 060183 293190 855201 559214 328238 239256 331271 527
　东北部59 17160 22159 83857 33159 23360 37163 59968 39970 35375 64778 866
每千人口执业医师数/人
　全国0.480.490.510.510.530.550.580.630.680.740.78
　东部0.510.530.570.570.590.610.660.720.780.830.88
　中部0.420.430.440.450.470.490.520.540.580.650.70
　西部0.470.480.480.480.490.510.530.560.620.670.71
　东北部0.540.560.560.540.570.580.620.680.700.770.81
), ArticleFig(id=1320442591527682151, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320442586146390052, language=EN, label=Tab.2, caption=

Turnover patterns of PHC physicians in China, 2011–2021

, figureFileSmall=null, figureFileBig=null, tableContent=
项目2011年2012年2013年2014年2015年2016年2017年2018年2019年2020年2021年
基层流动执业医师数/人18 30822 86742 71512 99024 76433 56126 92640 44243 14154 09064 560
基层间流动执业医师数/人7654986419 816575611 14514 55812 07017 79919 37824 99630 015
基层间流动执业医师占比/%41.843.146.444.345.043.444.844.044.946.246.5
非基层流向基层流动执业医师数/人5800623510 7292 97760359260793612 48313 27916 73819 014
非基层流向基层流动执业医师占比/%31.727.325.122.924.427.629.530.930.830.929.5
基层流向非基层流动执业医师数/人4854676812 170425775849743692010 16010 48412 35615 531
基层流向非基层流动执业医师占比/%26.529.628.532.830.629.025.725.124.322.824.1
基层执业医师净流动率/%0.22–0.12–0.29–0.25–0.30–0.090.180.390.430.630.46
), ArticleFig(id=1320442591619956840, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320442586146390052, language=CN, label=表2, caption=

2011—2021年中国基层卫生医疗机构执业医师流动特征

, figureFileSmall=null, figureFileBig=null, tableContent=
项目2011年2012年2013年2014年2015年2016年2017年2018年2019年2020年2021年
基层流动执业医师数/人18 30822 86742 71512 99024 76433 56126 92640 44243 14154 09064 560
基层间流动执业医师数/人7654986419 816575611 14514 55812 07017 79919 37824 99630 015
基层间流动执业医师占比/%41.843.146.444.345.043.444.844.044.946.246.5
非基层流向基层流动执业医师数/人5800623510 7292 97760359260793612 48313 27916 73819 014
非基层流向基层流动执业医师占比/%31.727.325.122.924.427.629.530.930.830.929.5
基层流向非基层流动执业医师数/人4854676812 170425775849743692010 16010 48412 35615 531
基层流向非基层流动执业医师占比/%26.529.628.532.830.629.025.725.124.322.824.1
基层执业医师净流动率/%0.22–0.12–0.29–0.25–0.30–0.090.180.390.430.630.46
), ArticleFig(id=1320442591729008745, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320442586146390052, language=EN, label=Tab.3, caption=

Distribution of physician turnover between PHC and non-PHC institutions in China, 2011–2021

, figureFileSmall=null, figureFileBig=null, tableContent=
项目2011年2012年2013年2014年2015年2016年2017年2018年2019年2020年2021年
非基层流向基层/%
　从医院流入基层89.288.887.081.883.480.183.484.987.888.288.6
　从专业公共卫生机构流入基层9.810.011.016.415.019.015.314.111.410.810.3
　从其他医疗卫生机构流入基层0.91.22.11.81.50.91.31.00.71.01.1
基层流向非基层/%
　从基层流入医院84.985.277.585.884.385.886.888.388.085.186.2
　从基层流入专业公共卫生机构14.013.921.313.014.713.312.210.810.211.611.9
　从基层流入其他医疗卫生机构1.10.91.21.21.10.91.10.91.83.31.9
), ArticleFig(id=1320442591859032170, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320442586146390052, language=CN, label=表3, caption=

2011—2021年中国基层与非基层医疗卫生机构执业医师流动分布情况

, figureFileSmall=null, figureFileBig=null, tableContent=
项目2011年2012年2013年2014年2015年2016年2017年2018年2019年2020年2021年
非基层流向基层/%
　从医院流入基层89.288.887.081.883.480.183.484.987.888.288.6
　从专业公共卫生机构流入基层9.810.011.016.415.019.015.314.111.410.810.3
　从其他医疗卫生机构流入基层0.91.22.11.81.50.91.31.00.71.01.1
基层流向非基层/%
　从基层流入医院84.985.277.585.884.385.886.888.388.085.186.2
　从基层流入专业公共卫生机构14.013.921.313.014.713.312.210.810.211.611.9
　从基层流入其他医疗卫生机构1.10.91.21.21.10.91.10.91.83.31.9
), ArticleFig(id=1320442591955501163, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320442586146390052, language=EN, label=Tab.4, caption=

Equity effects of PHC physician turnover in China, 2011–2021

, figureFileSmall=null, figureFileBig=null, tableContent=
项目2011年2012年2013年2014年2015年2016年2017年2018年2019年2020年2021年
基尼系数
　事实0.1420.147 00.141 00.136 00.136 00.133 00.131 00.135 00.126 00.123 00.123 0
　反事实0.146 00.140 00.131 00.136 00.131 00.129 00.134 00.125 00.119 00.121 0
　反事实—事实–0.000 2–0.001 9–0.004 4–0.000 6–0.001 2–0.001 9–0.000 9–0.001 9–0.003 2–0.002 6
泰尔指数
　事实0.0330.035 00.032 00.029 00.030 00.029 00.028 00.030 00.027 00.025 00.025 0
　反事实0.035 00.031 00.027 00.029 00.028 00.027 00.029 00.026 00.023 00.024 0
　反事实—事实–0.000 3–0.000 8–0.001 9–0.000 3–0.000 6–0.000 7–0.000 3–0.001 0–0.001 4–0.001 0
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2011—2021年中国基层医疗卫生机构执业医师流动配置公平性效应分析

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项目2011年2012年2013年2014年2015年2016年2017年2018年2019年2020年2021年
基尼系数
　事实0.1420.147 00.141 00.136 00.136 00.133 00.131 00.135 00.126 00.123 00.123 0
　反事实0.146 00.140 00.131 00.136 00.131 00.129 00.134 00.125 00.119 00.121 0
　反事实—事实–0.000 2–0.001 9–0.004 4–0.000 6–0.001 2–0.001 9–0.000 9–0.001 9–0.003 2–0.002 6
泰尔指数
　事实0.0330.035 00.032 00.029 00.030 00.029 00.028 00.030 00.027 00.025 00.025 0
　反事实0.035 00.031 00.027 00.029 00.028 00.027 00.029 00.026 00.023 00.024 0
　反事实—事实–0.000 3–0.000 8–0.001 9–0.000 3–0.000 6–0.000 7–0.000 3–0.001 0–0.001 4–0.001 0
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中国基层医疗卫生机构执业医师流动特征及其配置公平性效应实证：基于2011—2021年回顾性队列分析
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王晓旭 1 , 胡萌萌 2 , 马艺文 3 , 张耀光 1, *, *
中国公共卫生 | 专题报道——加强公共卫生人才队伍建设 2026,42(2): 136-140
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中国公共卫生 |专题报道——加强公共卫生人才队伍建设 2026 , 42 (2) : 136 -140
中国基层医疗卫生机构执业医师流动特征及其配置公平性效应实证：基于2011—2021年回顾性队列分析
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王晓旭1, 胡萌萌2, 马艺文3, 张耀光1, *, *
作者信息
  • 1国家卫生健康委统计信息中心，北京 100044
  • 2中南大学湘雅公共卫生学院，长沙 410031
  • 3北京大学医学部公共卫生学院，北京 100083
通讯作者:
张耀光，E-mail：
作者简介:

王晓旭（1993—），助理研究员，博士，研究方向：卫生人力资源

An empirical study on primary health care physician turnover pattern and its impact on equity of distribution in China: a retrospective cohort analysis from 2011 to 2021
Xiaoxu WANG1, Mengmeng HU2, Yiwen MA3, Yaoguang ZHANG1
Affiliations
  • 1National Health Commission Statistical Information Center, Beijing 100044, China
  • 2Xiangya School of Public Health, Central South University, Changsha 410031, China
  • 3Peking University School of Public Health, Beijing 100083, China
    • Corresponding Author:
    ZHANG Yaoguang, E-mail:
出版时间: 2026-02-10 doi: 10.11847/zgggws1148000
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摘要
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目的

分析2011—2021年中国基层医疗卫生机构执业医师分布现状、流动情况及其对整体配置公平性的影响，为优化基层执业医师配置和队伍建设提供实证依据。

方法

利用国家卫生健康统计职能部门采集的卫生人力基本信息调查表，将截至2022年4月采集的信息以人为单位纵向链接构建回顾性队列数据，解释中国执业医师流动特征，采用基尼系数和泰尔指数测算执业医师分布公平性系数，并通过反事实方法量化评估流动的配置公平性效应。

结果

中国基层医疗卫生机构执业医师数和每千人口执业医师数分别从2011年的644 858人和0.48人增长到2021年的1 102 532人和0.78人；2011—2021年纳入队列研究的3 696 434名执业医师中，有384 364名执业医师流动与基层医疗卫生机构有关，其中以在基层医疗卫生机构间流动为主[173 051人（45.0%）]，基层医疗卫生机构执业医师净流动率从2011年的0.22%波动性增长到2021年的0.46%；事实基尼系数和泰尔指数分别从2011年的0.142和0.033下降到2021年的0.123和0.025，反事实基尼系数和泰尔指数分别从2012年的0.146和0.035下降到2021年的0.121和0.024，基层医疗卫生机构执业医师流动配置公平性有所提升；2012—2021年各年“反事实—事实”结果均为负值且绝对值为0.000 2～0.004 4，执业医师流动对基层医疗卫生机构执业医师配置公平性影响甚微。

结论

2011—2021年中国基层医疗卫生机构执业医师发展态势较好，应继续加强人员动态监测，引导卫生人力资源合理流动。

执业医师  /  流动特征  /  配置  /  公平性效应  /  回顾性队列分析  /  基层医疗卫生机构  /  中国
Objective

To analyze the distribution situation and turnover of primary health care (PHC) physicians and its impact on equity of distribution in China from 2011 to 2021, thereby providing empirical evidence for optimizing the allocation and workforce development of PHC physicians.

Methods

We used the basic information of health human resources collected by the National Health Commission Statistical Information Center. Individual-level data collected by April 2022 were longitudinally linked to construct a retrospective cohort for analysis of the turnover pattern of PHC physicians. The Gini coefficient and Theil index were calculated to measure the equity of distribution. We performed counterfactual analysis to evaluate the impact of turnover on distribution equity.

Results

The number of PHC physicians and the number per thousand population in China increased from 644 858 and 0.48 in 2011 to 1 102 532 and 0.78 in 2021, respectively. Among the 3 696 434 PHC physicians enrolled in the cohort study from 2011 to 2021, a total of 384 364 turnover events were related to PHC institutions, primarily occurring between PHC institutions [173 051 (45.0%)]. The net turnover rate of PHC physicians increased from 0.22% to 0.46% with fluctuations. The factual Gini coefficient and Theil index decreased from 0.142 and 0.033 in 2011 to 0.123 and 0.025 in 2021, respectively, while the counterfactual Gini coefficient and Theil index declined from 0.146 and 0.035 in 2012 to 0.121 and 0.024 in 2021, respectively, which suggested improved equity in the distribution of PHC physicians. From 2012 to 2021, the annual "counterfactual minus factual" results were persistently negative with absolute values ranging from 0.000 2 to 0.004 4, suggesting that physician turnover had a minimal impact on the equity of physician distribution.

Conclusions

The development of PHC physicians in China shows a positive trend. Continuous efforts should be made to strengthen the dynamic monitoring and guide the rational turnover of PHC human resources.

practicing physicians  /  turnover patterns  /  resource allocation  /  equity effects  /  retrospective cohort analysis  /  primary health care institutions  /  China
王晓旭, 胡萌萌, 马艺文, 张耀光. 中国基层医疗卫生机构执业医师流动特征及其配置公平性效应实证：基于2011—2021年回顾性队列分析. 中国公共卫生, 2026 , 42 (2) : 136 -140 . DOI: 10.11847/zgggws1148000
Xiaoxu WANG, Mengmeng HU, Yiwen MA, Yaoguang ZHANG. An empirical study on primary health care physician turnover pattern and its impact on equity of distribution in China: a retrospective cohort analysis from 2011 to 2021[J]. Chinese Journal of Public Health, 2026 , 42 (2) : 136 -140 . DOI: 10.11847/zgggws1148000
正文
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医师流动不仅反映了个体职业选择，也反映了机构运营稳定性，更是对现有医师人力资源的再配置[1]。《关于深化医药卫生体制改革的意见》[2]和《“十四五”卫生健康人才发展规划》[3]明确提出，要加强基层医疗卫生服务能力，为群众提供安全、有效、方便、价廉的医疗卫生服务。加强基层人才队伍建设，将人才吸引并留在基层医疗卫生机构是“强基工程”的重中之重。然而，目前国内外关于基层医疗卫生机构执业医师流动的研究多基于小范围的调查数据开展，且较多仅采集到流动意愿而非流动行为[4–6]，缺乏全国范围的医师流动实证分析，难以为中国基层医疗卫生机构执业医师人力资源相关政策制定提供决策支撑和科学依据。有研究表明，公平可及的基层医疗卫生服务是提升健康解决的关键[7]。因此，有必要评估现有配置公平性水平并探究基层医疗卫生机构执业医师流动的公平性效应。为分析2011—2021年中国基层医疗卫生机构执业医师分布现状、流动情况及其对整体配置公平性的影响，为优化基层执业医师配置和队伍建设提供实证依据，本研究利用国家卫生健康统计部门采集的卫生人力基本信息调查表，将截至2022年4月采集的信息以人为单位纵向链接构建回顾性队列数据，解释中国执业医师流动特征，采用基尼系数和泰尔指数测算执业医师分布公平性系数，并通过反事实方法量化评估流动的配置公平性效应。结果报告如下。
1　资料与方法
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1.1　资料来源
中国基层医疗卫生机构执业医师分布数据来源于《中国卫生健康统计年鉴》。流动特征和流动率等数据来源于国家卫生健康委统计信息中心自2009年起依法采集的卫生人力基本信息数据库，该数据具有较好的全国代表性，包含全国100万余家注册医疗卫生机构（涵盖医院、基层医疗卫生机构、专业公共卫生机构和其他医疗卫生机构）报送的所有在岗职工基本信息，采集字段包括入职和离职时间以及按年更新的员工学历、职称等信息，多机构注册执业的医师由第一执业机构上报以避免重复统计。本研究从该数据库申请提取了截至2022年4月采集的执业医师数据，利用唯一匿名身份识别码将历年执业医师信息纵向链接构建回顾性队列，收集执业医师的执业机构、学历提升和职称晋升等信息的变更情况及变更时间。本研究仅纳入医疗卫生机构在岗执业医师，不包括执业助理医师和见习医师，流动执业医师指在2011—2021年变更了≥1次执业机构的医师，如毕业生等新流入中国医师人力资源池，或者因自然死亡或退休流出的均不纳入流动医师范畴。由于大部分有效信息只发生了1次机构变更，为数据处理方便和统一流动定义，本研究的流动仅考虑执业医师的首次流动。本研究涉及医师个案信息，但研究中所用数据中的人员唯一识别代码均已被数据采集单位国家卫生健康委统计信息中心匿名化处理，且无其他可识别个体的信息，研究者无法联系到所有的研究对象，北京大学生物医学伦理委员会批准了本研究的豁免知情同意书申请（批号：IRB00001052–23044）。
1.2　统计分析
采用SAS 9.4软件进行纵向数据库链接，应用Stata MP 17.0统计软件进行描述性分析、执业医师配置公平性分析和反事实分析，使用conindex程序包测算基尼系数和泰尔指数。
1.2.1　描述性统计
利用《中国卫生健康统计年鉴》中的基层医疗卫生机构执业医师数和国家统计局公布人口数描述我国基层医疗卫生机构执业医师数量及地区分布情况，计算我国每千人口基层医疗卫生机构执业医师数描述区域配置情况。根据本研究构建的全国医师人力资源纵向队列描述基层医疗卫生机构执业医师的流向并计算净流动率。计算公式为：
$\begin{split} &\;\;\;\;\;\;\;\;\;净流动率= （{ \text{流动进入基层的执业医师数}-\text{流动}}\\&\text{离开基层的执业医师数}）\div \text{年初和年末的基层执业医}\\&{\text{师平均值}}\times100{\text{%}}\\[-1pt]\end{split}$
净流动率为正值说明处于净流动入状态，负值则为净流出状态。
1.2.2　公平性评价
使用基尼系数和泰尔指数评价基层医疗卫生机构执业医师配置的公平性。基尼系数是国际上通用的、用以衡量一个国家或地区居民收入差距的常用指标之一[8]，目前也是衡量卫生资源配置公平性的常用工具，其计算公式为：
$G=1-{\sum }_{i=0}^{k-1}({Y}_{i+1}+{Y}_{i})({X}_{i+1}-{X}_{i})$
其中，$ {X}_{i} $为按人均基层医疗卫生机构执业医师占比排序后第i省人口累积百分比，$ {Y}_{i} $为按人均基层医疗卫生机构执业医师占比排序后第i省执业医师累积百分比，$ k $为省份总数。基尼系数的值介于0～1，其中0表示完全平等（即每个个体的医师资源完全相同），而1表示完全不平等（即所有的医师资源集中在1个个体手中）。泰尔指数是基于信息理论中熵的概念提出的、旨在降低信息不确定性的指标，近年来在医疗卫生资源公平性研究中有广泛的应用[9]，其计算公式为：
$T={\sum }_{i=1}^{k}{P}_{i}{\mathrm{ln}}\frac{{P}_{i}}{{E}_{i}}。$
其中，$ {P}_{i} $为第i省人口累积百分比，$ {E}_{i} $为第i省基层医疗卫生机构执业医师累积百分比，$ k $为省份总数。泰尔指数用于分析资源分配的不公平程度，值越大表示不公平程度越高，值越小表示公平程度越低[10]。
1.2.3　反事实分析
为量化基层医疗卫生机构执业医师流动公平性效应，本研究采用反事实分析方法[11]，以2011—2021年《中国卫生健康统计年鉴》公布的历年基层医疗卫生机构执业医师数为事实数据，基于本研究构建的执业医师队列数据计算分年份、分地区的执业医师净流动率，之后逐年倒推，如没有流动年份、分地区的执业医师数，即反事实数据。分别用事实和反事实数据计算医师分布公平性系数，并计算反事实减去事实的差值。基尼系数和泰尔指数均是数值越高，不公平性越大，因此“反事实—事实”为正值，说明反事实更高，不公平性更大，即，如果没有流动会更不公平，也就是说流动产生正向效应；反之，若“反事实—事实”为负值，说明流动产生负向效应。
2　结　果
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2.1　中国基层医疗卫生机构2011—2021年执业医师地区分布和千人口配置情况（表1）
中国基层医疗卫生机构执业医师数持续增长，从2011年的644 858人增长到2021年的1 102 532人，增长了457 674人，年均增速为5.5%。从地区分布看，2011—2021年我国基层医疗卫生机构执业医师在各地区的总数均呈持续增长态势，排序从高到低始终为东部、西部、中部和东北部地区，分别从2011年的264 890、148 865、171 932和59 171人增长到2021年的496 619、255 520、271 527和78 866人，年均增速分别为6.5%、5.6%、4.7%和2.9%。全国每千人口基层医疗卫生机构执业医师数从2011年的0.48增长至2021年的0.78，年均增速为5.0%。东部地区每千人口基层医疗卫生机构执业医师数2013年反超东北地区，之后一直领先，在研究期间的增量最大（0.37）且年均增速最高（5.6%）；中部地区2011—2021年每千人口基层医疗卫生机构执业医师数配置水平始终最低，但年均增速较快为5.2%；西部地区2011—2021年每千人口基层医疗卫生机构执业医师数增量最小（0.24），年均增速为4.2%；东北地区2011—2021年每千人口基层医疗卫生机构执业医师数增量为0.27，年均增速最低为4.1%。
2.2　2011—2021年中国基层医疗卫生机构执业医师流动特征（表2、3）
2011—2021年纳入的3 696 434名在岗执业医师中有384 364名执业医师流动与基层医疗卫生机构有关，其中在基层医疗卫生机构间流动者173 051人（45.0%），流动进入基层医疗卫生机构者110 486人（28.7%），流动离开基层医疗卫生机构者100 827人（26.2%），且2011—2021年3种流向流动执业医师占比无明显变化，流动规模均呈波动性增长，净流动率绝对值也呈波动性上升态势。其中，2017年起基层医疗卫生机构执业医师净流动率从负值转为正值，基层医疗卫生机构对流动执业医师的吸引力有所提升（见表2）。不同流向执业医师流动情况比较，从医院流入基层医疗卫生机构和从基层医疗卫生机构流入医院的执业医师占比均最高（均>75%）（见表3）。
2.3　2011—2021年中国基层医疗卫生机构执业医师流动配置公平性效应分析（表4）
2011—2021年按事实和反事实计算的基尼系数和泰尔指数均呈波动性下降态势，事实基尼系数和泰尔指数分别从2011年的0.142和0.033下降到2021年的0.123和0.025，反事实基尼系数和泰尔指数分别从2012年的0.146和0.035下降到2021年的0.121和0.024，基层医疗卫生机构执业医师流动配置公平性有所提升；2012—2021年各年“反事实—事实”结果均为负值且绝对值为0.000 2～0.004 4，执业医师流动对基层医疗卫生机构执业医师配置公平性影响甚微。
3　讨　论
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本研究结果显示，在国家政策持续引导下，中国2011—2021年基层医疗卫生机构执业医师数和每千人口执业医师数均呈增长趋势，反映当前国家围绕“强基层，引人才”所开展的各项工作取得了阶段性成果。研究结果显示，基层医疗卫生机构执业医师配置公平性持续提升，与既往采用集聚度、集中指数和洛伦兹曲线等方法衡量医师分布公平性研究的结论一致[12–14]，提示我国基层医疗卫生机构人力资源总量不断增加，整体配置公平性不断提升。
本研究结果显示，我国执业医师流动以基层医疗卫生机构间流动为主[173 051人（45.0%）]，跨机构类型流动使得基层医疗卫生机构执业医师数量扩充医院与基层相互流动最多，且体量非常接近，2017年后基层执业医师始终处于净流入，整体呈现出基层医疗卫生机构对执业医师的吸引力增强。既往研究表明，基层医疗卫生机构存在“留人难、用人难”的情况，主要是由于基层待遇水平低[15]，因此，提高待遇是稳定和巩固基层人才的关键[16–17]。我国《医药卫生中长期人才发展规划（2011—2020年）》[18]和《深化医药卫生体制改革2019年重点工作任务》[19]等多项政策均强调，要提高基层人才待遇并加大基层对优秀人才的吸引力。此外，近年来我国不断加强医联体、医共体和区域医疗中心建设，提高了不同医疗卫生机构间的互动，也畅通了优质医师资源下沉和基层人才在上级机构交流的渠道[20]，同时提高了基层医疗卫生机构的整体诊治水平，为基层人才队伍打造了更好的发展平台，持续提高基层医疗卫生机构对执业医师的吸引力。
反事实分析结果显示，2012—2021年各年“反事实—事实”结果均为负值且绝对值为0.000 2～0.004 4，执业医师流动对基层医疗卫生机构执业医师配置公平性影响甚微，主要是因为我国目前流动执业医师的体量相对执业医师总量较小，接近一半的流动发生在基层医疗卫生机构之间，且不同医疗卫生机构间的流动也整体有利于基层队伍扩充。然而，本研究结果显示，基层医疗卫生机构执业医师流动呈现出一定的负面作用，既往有关医师流动意愿的研究亦发现，基层医师特别是高学历医师更希望有机会前往上级医疗机构工作从而充分实现其专业价值[6]。有研究表明，加大财政投入、构建合理的薪酬分配制度和考评激励机制是提高基层人才队伍黏性的重点策略[13, 21]。因此，为引导医疗卫生资源合理流动，应继续加强基层医师动态监测，准确把握人才流向，为科学制定政策提供依据。

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1
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2026年第42卷第2期
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doi: 10.11847/zgggws1148000
  • 接收时间：2025-05-20
  • 首发时间：2026-10-23
  • 出版时间：2026-02-10
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  • 收稿日期：2025-05-20
  • 修回日期：2025-07-28
  • 录用日期：2025-09-16
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    1国家卫生健康委统计信息中心，北京 100044
    2中南大学湘雅公共卫生学院，长沙 410031
    3北京大学医学部公共卫生学院，北京 100083

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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