Influencing factors of health resource allocation and utilisation before and after COVID-19 based on RIF-I-OLS decomposition method: a longitudinal retrospective study in Guangdong Province, China.

Objectives: To explore factors that influenced the health resource allocation and utilisation before and after COVID-19, and subsequently offer sensible recommendations for advancing the scientific distribution of health resources.

Design: A longitudinal survey using 2017-2020 data, which were collected for analysis.

Setting: The study was conducted based on data collected from the Health Commission of Guangdong Province's website.

Outcome Measures: Eight health resource indicators and four health resource utilisation indicators were included in the factor analysis. Four indices were calculated to measure the inequality in health resource allocation and utilisation. We analysed factors for the inequality indices using the recentred influence function index ordinary least squares decomposition method.

Results: The health resource inequality indices peaked in 2020 (Gini coefficient (Gini): 0.578, Absolute Gini coefficient (AGini): 1.136, Concentration Index (CI): 0.417, Absolute CI (ACI): 0.821), whereas the health resource utilisation inequality indices declined year by year, thus reaching their lowest point in that same year. The majority of inequality indices in the annual change of health resource allocation were at their lowest in 2020 (Gini: -1.672, AGini: 0.046, CI: -0.189, ACI: 0.005), while the use of health resources declined dramatically, showing a negative growth trend. The inequality indices of health resource allocation and utilisation in 2020 were affected by a number of variables, including the COVID-19 level, (p<0.05), while the proportion of expenditure on public health was the most significant one.

Conclusions: Guangdong Province's health resource allocation and utilisation were still concentrated in economically developed regions from 2017 to 2020. The health resource allocation inequality indices increased, especially under COVID-19, but the health resource utilisation inequality indices decreased. Measures should be taken to adjust the health resource allocation scientifically, which will fulfil the changing needs and the use of resources more efficiently. One effective measure is reasonably increasing the proportion of expenditure on public health.