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Versorgungsbedarf, Angebot und Inanspruchnahme ambulanter hausärztlicher Leistungen im kleinräumigen regionalen Vergleich

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Anke Schliwen

Die Sicherstellung einer flächendeckenden, wohnortnahen und bedarfsgerechten Versorgung ist ein zentrales Anliegen der deutschen Gesundheitspolitik. Anke Schliwen untersucht den regionalen Zusammenhang von Versorgungsbedarf, Angebot und Inanspruchnahme hausärztlicher Leistungen. Dabei wird der Versorgungsbedarf anhand eines multifaktoriellen Index auf der kleinräumigen Ebene der Mittelbereiche operationalisiert. Eine Clusteranalyse ermöglicht die Identifikation von Regionstypen, deren Eigenschaften Ansatzpunkte für eine Neuordnung der Ressourcenallokation bieten können. Mit ihrem Buch unterstreicht die Autorin die Notwendigkeit, innerhalb zentraler Rahmenbedingungen den Einsatz regionaler Planungs- und Steuerungsinstrumente zur Verteilung von ärztlichen Kapazitäten zu ermöglichen.
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Abstract

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 systematic 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 socioeconomics, 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 utilization are the regional supply structure (including both general and specialized doctors) and the attractiveness of the region in terms of profitability and sociocultural environment. Other influences such as the geographical availability and ethnicity of the population prove to be less important to explain regional inequity in health care use.

The detected heterogeneity of health care indicators on a small-scale regional level supports the request for a central planning system that allows the application of local planning- and control instruments to distribute doctor capacities and financial resources under consideration of regional capacities and influencing factors. In order to adjust for the diverse regional circumstances and unequal attractiveness, a prospective and longitudinal balancing system on a national level is needed. This should include both positive and negative incentives for doctors’ choice of practice location. Both the identification of small-scale problems and the development of successful intervention methods to decrease over- and undersupply require coordination and cooperation of the different public planning systems and all stakeholders involved.