Association between the General Practitioner Workforce Crisis and Premature Mortality in Hungary: Cross-Sectional Evaluation of Health Insurance Data from 2006 to 2014

Abstract

The workforce crisis of primary care is reflected in the increasing number of general medical practices (GMP) with vacant general practitioner (GP) positions, and the GPs’ ageing. Our study aimed to describe the association between this crisis and premature mortality. Age-sex-standardized mortality for 18–64 years old adults was calculated for all Hungarian GMPs annually in the period from 2006 to 2014. The relationship of premature mortality with GPs’ age and vacant GP positions was evaluated by standardized linear regression controlled for list size, urbanization, geographical location, clients’ education, and type of the GMP. The clients’ education was the strongest protective factor (beta = −0175; p < 0.001), followed by urban residence (beta = −0.149; p < 0.001), and bigger list size (beta1601–2000 = −0.054; p < 0.001; beta2001−X = −0.096; p < 0.001). The geographical localization also significantly influenced the risk. Although GMPs with a GP aged older than 65 years (beta = 0; p = 0.995) did not affect the risk, GP vacancy was associated with higher risk (beta = 0.010; p = 0.033), although the corresponding number of attributable cases was 23.54 over 9 years. The vacant GP position is associated with a significant but hardly detectable increased risk of premature mortality without considerable public health importance. Nevertheless, employment of GPs aged more than 65 does not impose premature mortality risk elevation.

The impact of general practitioners’ gender on process indicators in Hungarian primary healthcare: a nation-wide cross-sectional study

“…The ratio of observed and expected values, representing the settlement-specific relative education, was used to express the relative education of adults living in a certain settlement compared with the national reference level. A weighted settlement-specific relative education variable was calculated for GMPs providing care for patients from more than one settlement 38…”

Evaluation of primary care services in Hungary

“…Ethnic minorities are represented in Hungary by the Roma population only, although it is forbidden by legislations to register the race in medical files. They have more morbidities and clearly lower life expectancies [24].…”

“…There are similar initiatives in Hungary as well [24]. Continuity and comprehensiveness of care are closely linked to national healthcare expenditures; however, coordination of care is not [27].…”

“…Recently, Hungarian health care system faces two major challenges, low financial resources and shortage of manpower, mainly in primary care [24]. The Hungarian population is yet satisfied with the PC system, although performances of other health care levels (mainly hospitals) are rated negatively.…”

Intervention and Public Policy Pathways to Achieve Health Care Equity

“…Population demand and supplier capacity should also be incorporated in planning. Sándor et al [16] proposed revising human resource policy in health care systems, i.e., retirement policy, so that sufficient providers are available to forestall increases in premature mortality when provider shortages exist. Nanney et al [17] posit that creating a climate for health system change can be based on assessing the cost of not making a change.…”