Distributional change in physician manpower, United States, 1963-80.

McConnel, Charles E.; Tobias, Lisa

doi:10.2105/ajph.76.6.638

Cited by 12 publications

(7 citation statements)

References 22 publications

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“…Limiting our operational definition to respondents' reports of problems obtaining needed care may have underestimated the importance of health system resources, for example. While we acknowledge access as a multidimensional concept [57], our findings are consistent with several studies examining indicators of realized access or use of a broad range health care services [37,57,[60][61][62][63][64][65][66][67][68]. Third, unreliable or invalid measures of health system resources may have resulted in missed associations.…”

Section: Discussionsupporting

confidence: 85%

“…Previous work has also attempted to develop mathematical models that identify under-served areas so that resources can be more readily deployed [47]. Despite this attention, evidence in recent years suggests that inequities in the distribution of health system resources and their use persists [37,57,[60][61][62][63][64][65][66][67][68]. Some have concluded that these efforts may have failed because they did not consider social or economic factors that contribute in potentially important ways to the difficulties residents encounter in accessing health care in the face of an apparently adequate supply of health care providers [51].…”

Section: Discussionmentioning

confidence: 99%

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Health care resource allocation and individuals’ health care needs: examining the degree of fit

Litaker

Love

2005

Health Policy

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Health care resource allocation and individuals’ health care needs: examining the degree of fit

Litaker

Love

2005

Health Policy

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“…Its value lies between 0 (no inequality) and 1 (complete inequality). These methods have been applied for studying the equal distribution of physicians [1,2,7,24-26]. …”

Section: Methodsmentioning

confidence: 99%

Redistributive effects of the National Health Insurance on physicians in Taiwan: a natural experiment time series study

Yang

Huang

Hsueh

2013

Int J Equity Health

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BackgroundPrevious studies have evaluated the effects of various health manpower policies but did not include full consideration of the effect of universal health insurance on physician re-distribution. This study examines the effects of implementing National Health Insurance (NHI) on the problem of geographic mal-distribution of health providers in Taiwan.MethodsData on health providers and population between 1971 and 2001 are obtained from relevant governmental publications in Taiwan. Gini coefficients derived from the Lorenz curve are used under a spline regression model to examine the impact of the NHI on the geographic distribution of health providers.ResultsThe geographic distribution equality of the three key health providers has improved significantly after the implementation of NHI program. After accounting for the influences of other confounding factors, Gini coefficients of the three key providers have a net reduction of 1.248% for dentists, 0.365% for western medicine physicians, and 0.311% for Chinese medicine physicians. Overall, the absolute values of the three key providers’ Gini coefficients also become close to one another.ConclusionsThis study found that NHI’s offering universal health coverage to all citizens and with proper financial incentives have resulted in more equal geographic distributions among the key health care providers in Taiwan.

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“…In the United States, empirical investigations into whether the geographic distribution of physicians has deteriorated or improved over time have tended to use the same methodological approach: namely, the Gini index of resource concentration. For example, the Gini index methodology has been employed by Politzer, Cultice and Meltzer (1998), Ricketts, Gesler andOsborne (1994), andMcConnel andTobias (1986). The index has been found to adequately and sensitively measure the degree of difference between two distributions.…”

Section: Methods and Datamentioning

confidence: 99%

Physician Distribution and Physician Shortage Intensity in Ontario

Kralj¹

2001

Canadian Public Policy / Analyse de Politiques

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Au cours des années 1990, en Ontario et dans de nombreuses autres jurisdictions, le point central du débat sur les ressources humaines en médecine s'est déplacé d'un surplus généralisé à une pénurie. Cependant, le problème demeure de l'accès équitable à ces ressources et aux services de santé en général. Pendant cette période, l'effort en matière de politiques gouvernementales a été largement orienté vers ce qui a été perçu comme une "maldistribution" des ressources entre les régions géographiques. Cet article applique l'index Gini, une méthodologie de la concentration des ressources, pour mesurer la maldistribution des ressources médicales en Ontario au cours des années 90. Notre article propose également et met en application, une méthode pour quantifier la pénurie de médecins au moyen d'un index de l'intensité de cette pénurie. Les résultats révèlent qu'en dépit de nombreuses politiques gouvernementales et de programmes destinés à remédier à la maldistribution géographique des ressources humaines dans le domaine médical, la répartition des médecins en Ontario est devenue plus inégale dans les années 90. Cela met en question l'efficacité des politiques gouvernementales quant à la correction de la maldistribution géographique. En outre, il n'y a pas eu de baisse significative de l'intensité de la pénurie générale de médecins au cours des années 90. During the 1990s, in Ontario and many other jurisdictions, the focus on the physician human resources debate has moved from aggregate surpluses to shortages. However, the problem of equitable access to those resources, and health services in general, has remained. During this period, much government policy effort has been targeted toward the perceived "maldistribution" of resources between geographic regions. This paper applies the Gini index of resource concentration methodology to gauge the maldistribution of physician resources in Ontario during the 1990s. It also proposes, and implements, an approach for quantifying physician shortages through a physician shortage intensity index. The results reveal that despite numerous government policies and programs aimed at alleviating the geographic maldistribution of medical human resources, the distribution of physicians in Ontario has become more uneven during the 1990s. This puts the efficacy of government policies to correct geographic maldistribution into question. Additionally, there has been no meaningful improvement in overall physician shortage intensity during the 1990s.

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Distributional change in physician manpower, United States, 1963-80.

Cited by 12 publications

References 22 publications

Health care resource allocation and individuals’ health care needs: examining the degree of fit

Health care resource allocation and individuals’ health care needs: examining the degree of fit

Redistributive effects of the National Health Insurance on physicians in Taiwan: a natural experiment time series study

Physician Distribution and Physician Shortage Intensity in Ontario

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