Versorgungsbedarf, Angebot und Inanspruchnahme ambulanter hausärztlicher Leistungen im kleinräumigen regionalen Vergleich
In face of growing inequalities in the availability of primary care physicians on a regional level, ensuring a spatially inclusive, comprehensive and needs-based distribution becomes a central concern of health care politicians in Germany. A “doctors’ shortage”, especially in rural and socially deprived areas is discussed widely. Given the current trend towards regionalization of resource allocation, growing inequity on a small area level and raising costs in health care, a system- atic empirical analysis of the local health care situation regarding the level of need, supply and use is needed. The results can help to develop and implement successful instruments striving for a more equal distribution of physicians and thereby supporting equal opportunities of health. In this dissertation need for health care is operationalized by a multifactor needs-index, including variables of demography, morbidity and socioeconom- ics, and compared as a relative concept to local supply and utilization of general practitioners. Geographical inequities in supply and use that cannot be explained by variation of need are found in three quarter of the analyzed regions. Based on their profile of the relative care indicators need, supply and use, the small-scale regions are clustered into regional types. Analyzing the characteristics of these types reveals that major driving forces of non-need-related inequalities in utili- zation are the regional supply structure (including both general and specialized doctors) and the attractiveness of the region in terms of profitability and so- ciocultural environment. Other influences such as the geographical availability and ethnicity of the population prove to...
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