Economic expansion is a major determinant of physician supply and utilization
Economic expansion is a major determinant of physician supply and utilization
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DOI：
10.1111/1475-6773.00139
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发表时间：
2003-04-01
影响因子：
3.4
通讯作者：
Laud, P
中科院分区：
文献类型：
--
作者：
Cooper, RA;Getzen, TE;Laud, P
客观的。评估经济发展水平与医生供给和利用之间的关系。数据来源数据来自美国医学会、美国整骨协会、经济合作与发展组织（OECD）、卫生职业局、劳工统计局、经济分析局、人口普查局、医疗保健融资管理局和历史来源。研究设计。以实际人均国内生产总值 (GDP) 或个人收入表示的经济发展与国家和州内 25-70 年期间的人均医疗保健劳动力和医生供应量以及国家、州和大都市统计区 (MSA) 之间长达 30 年的多个时间点的人均医疗保健劳动力和医生供应量相关。纵向数据以四种互补的方式进行分析：（1）简单单变量回归； (2) 时间趋势被部分排除的回归； (3) 比较不同时间段的百分比差异的时间序列； (4) 双变量格兰杰因果关系检验。通过单变量回归分析在多个时间点评估横截面数据。主要发现。在每个分析场景下；医生供应量与 GDP 或个人收入的差异相关。纵向相关性与卫生保健就业的时间滞后大约 5 年和医生供应变化的时间滞后相关 10 年。美国人均医生供应量的变化幅度相当于 GDP 每变化 1.0%，变化幅度约为 0.75%。经济扩张对医学专业的影响最大，而外科和医院专业受到的影响较小，经济扩张水平对家庭/全科医学的影响很小。结论。经济扩张与医生供应的变化有很强的滞后关系。这表明经济预测可以作为预测未来医生服务利用率的衡量标准。
Objective. To assess the relationship between levels of economic development and the supply and utilization of physicians.Data Sources Data were obtained from the American Medical Association, American Osteopathic Association, Organization for Economic Cooperation and Development (OECD), Bureau of Health Professions, Bureau of Labor Statistics, Bureau of Economic Analysis, Census Bureau, Health Care Financing Administration, and historical sources.Study Design. Economic development, expressed as real per capita gross domestic product (GDP) or personal income, was correlated with per capita health care labor and physician supply within countries and states over periods of time spanning 25-70 years and across countries, states, and metropolitan statistical areas (MSAs) at multiple points in time over periods of up to 30 years. Longitudinal data were analyzed in four complementary ways: (1) simple univariate regressions; (2) regressions in which temporal trends were partialled out; (3) time series comparing percentage differences across segments of time; and (4) a bivariate Granger causality test. Cross-sectional data were assessed at multiple time points by means of univariate regression analyses.Principal Findings. Under each analytic scenario; physician supply correlated with differences in GDP or personal income. Longitudinal correlations were associated with temporal lags of approximately 5 years for health employment and 10 years for changes in physician supply. The magnitude of changes in per capita physician supply in the United States was equivalent to differences of approximately 0.75 percent for each 1.0 percent difference in GDP. The greatest effects of economic expansion were on the medical specialties, whereas the surgical and hospital-based specialties were affected to a lesser degree, and levels of economic expansion had little influence on family/general practice.Conclusions. Economic expansion has a strong, lagged relationship with changes in physician supply. This suggests that economic projections could serve as a gauge for projecting the future utilization of physician services.