Inequality in the geographical distribution of general practitioners in England and Wales 1974-1995.
Inequality in the geographical distribution of general practitioners in England and Wales 1974-1995.
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DOI：
10.1258/1355819011927143
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发表时间：
2001-01-01
影响因子：
2.4
通讯作者：
Sutton, M
中科院分区：
文献类型：
--
作者：
Gravelle, H;Sutton, M
目的：比较英格兰和威尔士1995年前后全科医生(GP)、其他资源和死亡率分布的地域不平等；测量1974-1995年间全科医生分配不平等的趋势；检查不同需求调整和不平等措施对地理不平等程度的影响；分析政策(增加供应、地区诱因和进入管制)对不平等的影响。方法：测量1974-1995年前家庭医生委员会/家庭服务管理局地区全科医生与需要调整的人口比例的相对不平等(十进比、基尼系数、阿特金森指数)和绝对不平等(标准差)；以及1995年前后各地区在收入、其他资源和标准化死亡率分配方面的相对不平等。1995年总人口/人口比率与1974年比率的回归。净优势区位均衡化模型在全科医生分配中的应用。结果：1995年全科医生分配的不平等小于其他初级保健资源的不平等，但大于可支配收入、SMR、小学支出、医院和社区卫生服务支出的不平等。十进制比率在1974至1995年间几乎没有变化。基尼和阿特金森不平等指数显示，1974年至1980年期间，不平等程度有所下降，但此后变化不大。在此期间，按需要调整的拨备的标准偏差有所增加。1974年总产值拨备最低的地区在1995年往往最低。结论：在相对和绝对不平等衡量标准之间的选择，以及在较小程度上根据需要进行调整的方法，会影响关于不平等趋势的结论。这两类措施和大多数需要调整的措施都表明，所采取的政策在此期间并没有减少不平等现象。政策之间的相互作用可能会降低其整体效力。
OBJECTIVES: To compare geographical inequality in the distribution of general practitioners (GPs), other resources and mortality around 1995 in England and Wales; to measure trends between 1974 and 1995 in inequality of GP distribution; to examine the implications of different need adjustments and inequality measures on the degree of geographic inequality; and to analyse the impact of policies (increased supply, area inducements and entry regulation) on inequality.METHODS: Measurement of relative inequality (decile ratio, Gini coefficient, Atkinson index) and absolute inequality (standard deviation) in the ratio of GPs to need-adjusted population in former Family Practitioner Committee/Family Health Services Authority areas each year from 1974 to 1995; and relative inequality across areas in the distributions of income, other resources and standardised mortality ratios (SMRs) around 1995. Regression of 1995 GP/population ratios on 1974 ratios. Application of equalising net advantages location model to GP distribution.RESULTS: Inequality in the distribution of GPs in 1995 was less than inequality in other primary care resources, but greater than inequalities in disposable income, SMRs, primary school expenditure, and hospital and community health services expenditure. The decile ratio shows little change between 1974 and 1995. Gini and Atkinson inequality indices indicate some reduction in inequality between 1974 and 1980, but little change thereafter. The standard deviation of need-adjusted provision increased over the period. Areas that had the lowest GP provision in 1974 tended to have the lowest in 1995.CONCLUSIONS: The choice between relative and absolute inequality measures and, to a lesser extent, the method of adjusting for need affect conclusions about the trend in inequality. Both types of measure and most need adjustments suggest that the policies adopted did not lead to a reduction in inequality over the period. Interactions between policies may reduce their overall effectiveness.