General practitioners in German metropolitan areas – distribution patterns and their relationship with area level measures of the socioeconomic status

Abstract

BackgroundGeographical variation of the general practitioner (GP) workforce is known between rural and urban areas. However, data about the variation between and within urban areas are lacking.MethodWe analyzed distribution patterns of GP full time equivalents (FTE) in German cities with a population size of more than 500,000. We correlated their distribution with area measures of social deprivation in order to analyze preferences within neighborhood characteristics. For this purpose, we developed two area measures of deprivation: Geodemographic Index (GDI) and Cultureeconomic Index (CEI).ResultsIn total n = 9034.75 FTE were included in n = 14 cities with n = 171 districts. FTE were distributed equally on inter-city level (mean: 6.49; range: 5.12–7.20; SD: 0.51). However, on intra-city level, GP distribution was skewed (mean: 6.54; range: 1.80–43.98; SD: 3.62). Distribution patterns of FTE per 10^4 residents were significantly correlated with GDI (r = −0.49; p < 0.001) and CEI (r = −0.22; p = 0.005). Therefore, location choices of GPs were mainly positively correlated with 1) central location (r = −0.50; p < 0.001), 2) small household size of population (r = −0.50; p < 0.001) and 3) population density (r = 0.35; p < 0.001).ConclusionIntra-city distribution of GPs was skewed, which could affect the equality of access for the urban population. Furthermore, health services planners should be aware of GP location preferences. This could be helpful to better understand and plan delivery of health services. Within this process the presented Geodemographic Index (GDI) could be of use.

Geographic accessibility to primary care providers: Comparing rural and urban areas in Southwestern Ontario

“…The E2SFCA method stems from the floating catchment area (FCA) approach that uses spatial interaction processes in the manipulation of supply and demand (Luo and Qi ). The FCA approach provides a unique platform for developing sophisticated methods and has been widely used for modelling spatial aspects of health care accessibility (Ngamini Ngui and Vanasse ; Bauer et al ; Bauer et al ). The E2SFCA method is a modification to the original 2‐step floating catchment area (2SFCA) method by “addressing the problem of uniform access within the catchment by applying weights to different travel time zones to account for distance decay” (Luo and Qi , 1100).…”

“…Contextual factors (e.g., place of residence, distance to facilities, and transport infrastructure) can serve as barriers or facilitators to accessing health care resources (Chan et al 2006;Cinnamon et al 2008;McDonald et al 2017;Wang et al 2017), which are in turn associated with health outcomes (Subramanian 2004;Holtz et al 2014). Health care accessibility is inversely associated with distance or travel time and is sensitive to where people are located within a large metropolitan area (Guagliardo et al 2004;Charreire and Combier 2009;Bauer et al 2016;Shah et al 2016;Gilliland et al 2019) and/or across the urban-rural continuum (Cinnamon et al 2008;McGrail and Humphreys 2015;McDonald et al 2017;Shah et al 2017). Even within urban areas, transportation is one of the most commonly cited barriers to primary care access (McColl et al 2015;South East Local Health Integration Network 2015).…”

Workforce crisis in primary healthcare worldwide: Hungarian example in a longitudinal follow-up study

“…The Position Paper of the Irish Medical Organisation on health inequalities denotes that vulnerable rural and deprived urban communities have no adequate GP cover in Ireland 13. Demographic studies identified a shortage of PC service providers located in the countryside and a relative oversupply in metropolitan areas in Germany, and in German cities with a population size of more than 500 000 the distribution patterns of GPs were significantly correlated with the geodemographic index, an area measure of deprivation 14. Although the Royal College of General Practitioners reported that the so-called ‘underdoctored’ areas are the most-deprived regions of the UK, that is, ‘the general practice workforce is unevenly spread across the country, with the fewest doctors in the most-deprived areas, exacerbating health inequalities’,15 it is worth mentioning that there was a substantial reduction in socioeconomic inequality in family physician supply associated with national policy for establishing new practices in the most deprived areas under the ‘Equitable Access to Primary Medical Care (EAPMC)’ programme 16…”

Distribution of Health Care Resources in Austria – Inequality Assessment of Different Health Care Resources at Different Points in Time

“…Previous studies have revealed that specific population and neighborhood characteristics, such as unemployment, older population, proximity to hospitals and other health care providers, in addition to social and cultural amenities, affect physicians' practice location choices. [40][41][42] Further analyses into the physicians' settlement decisions are therefore necessary to derive suitable policy measures for incentivizing physicians not only to apply for SHI contracts but also to settle in non-urban areas. Such measures might include regulating the access to certain regions for private physicians or providing area-specific compensation payments for relatively unattractive regions.…”