Are Doctors Equally Distributed Throughout the World?
Abstract
Background: As the vital and scarce resource of the health system, physicians are responsible for treating patients and saving lives and the equitable distribution of physicians among the whole population is a prerequisite to achieving health for all. We aimed to investigate inequality in physician distribution in the world using the Gini coefficient.
Methods: This descriptive-analytical study was conducted in 2021. The number of physicians and the population of countries were obtained from the WHO and United Nations (UN) databases. The Gini coefficient was calculated in three different modes and the distribution of physicians among countries in various Human Development Index (HDI) groups was determined using the physician ratio per 10,000 population.
Results: There were generally more than 13 million doctors in the world. About 43% of the world's physicians were available to 20% of the world's population in very high HDI countries, and 12% of the population had access to about 1% of physicians in low HDI countries. An average of 19.5 physicians are distributed per 10,000 population worldwide. The Gini coefficient between the four groups of HDI countries was 0.55, and that of all countries in the world was 0.640.
Conclusion: There was a shortage and inequality in the distribution of physicians worldwide. Governments should eliminate inequality in the distribution of the medical workforce, in particular physicians, by redoubling their efforts and accurate planning.
2. Cao X, Bai G, Cao C, et al. (2020). Comparing Regional Distribution Equity among Doctors in China before and after the 2009 Medical reform policy: a data analysis from 2002 to 2017. Int J Environ Res Public Health, 17(5):1520.
3. Maffioli EM, Rocha TAH, Vivas G, et al. (2019). Addressing inequalities in medical workforce distribution: evidence from a quasi-experimental study in Brazil. BMJ Glob Health, 4(6):e001827.
4. Zhou K, Zhang X, Ding Y, et al. (2015). Inequality trends of health workforce in different stages of medical system reform (1985-2011) in China. Hum Resour Health,13:94.
5. Matsumoto M, Inoue K, Bowman R, et al. (2010). Geographical distributions of physicians in Japan and US: Impact of healthcare system on physician dispersal pattern. Health Policy, 96(3):255-61.
6. Shi L, Macinko J, Starfield B, et al. (2003). The relationship between primary care, income inequality, and mortality in US States, 1980–1995. J Am Board Fam Pract,16(5):412-22.
7. Tandi TE, Cho Y, Akam AJ-C, et al. (2015). Cameroon public health sector: shortage and inequalities in geographic distribution of health personnel. Int J Equity Health,14: 43.
8. Hara K, Kunisawa S, Sasaki N, et al. (2018). Examining changes in the equity of physician distribution in Japan: a specialty-specific longitudinal study. BMJ Open, 8(1):e018538.
9. Kruk ME, Gage AD, Arsenault C, et al. (2018). High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health, 6(11):e1196-e1252.
10. Kobayashi Y, Takaki H (1992). Geographic distribution of physicians in Japan. Lancet, 340(8832):1391-3.
11. Pál V, Lados G, Ilcsikné Makra Z, et al. (2021). Concentration and inequality in the geographic distribution of physicians in the European Union, 2006–2018. Regional Statistics,11(3):3-28.
12. Toyabe S-i (2009). Trend in geographic distribution of physicians in Japan. Int J Equity Health, 8:5.
13. Sousa A, Dal Poz MR, Carvalho CL (2012) . Monitoring inequalities in the health workforce: the case study of Brazil 1991-2005. PLoS One, 7(3):33399.
14. Rabbanikhah F, Moradi R, Mazaheri E, et al. (2018). Trends of geographic distribution of general practitioners in the public health sector of Iran. J Educ Health Promot, 7:89.
15. Ismail M (2020). Regional disparities in the distribution of Sudan's health resources. East Mediterr Health J, 26(9):1105-1114.
16. WHO. Medical doctors (per 10 000 population). https://www.who.int/data/gho/data/indicators/indicator-details/GHO/medical-doctors-(per-10-000-population)
17. worldbank. Physicians (per 1,000 people). https://data.worldbank.org/indicator/SH.MED.PHYS.ZS
18. https://hdr.undp.org/reports-and-publications/2020-human-development-report/data-readers-guide
19. Brown MC (1994) . Using Gini-style indices to evaluate the spatial patterns of health practitioners: theoretical considerations and an application based on Alberta data. Soc Sci Med,38(9):1243-56.
20. Mollahaliloglu S, Yardım M, Telatar TG, et al. (2021). Change in the geographic distribution of human resources for health in Turkey, 2002-2016. Rural Remote Health, 21(2):6478.
21. Rój J (2020). Inequality in the distribution of healthcare human resources in Poland. Sustainability, 12(5):2043.
22. Wiseman V, Lagarde M, Batura N, et al. (2017). Measuring inequalities in the distribution of the Fiji Health Workforce. Int J Equity Health, 16(1):115.
23. Newhouse JP (1990). Geographic access to physician services. Annu Rev Public Health,11(1):207-30.
24. Newhouse JP, Williams AP, Bennett BW, et al. (1982). Where have all the doctors gone? JAMA, 247(17):2392-6.
25. Schwartz WB, Newhouse JP, Bennett BW, et al. (1980). The changing geographic distribution of board-certified physicians. N Engl J Med, 303(18):1032-8.
26. Newhouse JP, Williams AP, Bennett BW, et al. (1982). Does the geographical distribution of physicians reflect market failure? Bell J Econ, 13(2): 493-505.
27. Cao X, Bai G, Cao C, et al. (2020). Comparing Regional Distribution Equity among Doctors in China before and after the 2009 Medical Reform Policy: A Data Analysis from 2002 to 2017. Int J Environ Res Public Health, 17(5):1520.
28. Paramita SA, Yamazaki C, Setiawati EP, et al. (2018). Distribution trends of Indonesia's health care resources in the decentralization era. Int J Health Plann Manage, 33(2):e586-e96.
29. Johnston G, Wilkinson D (2001). Increasingly inequitable distribution of general practitioners in Australia, 1986–96. Aust N Z J Public Health, 25(1):66-70.
30. Shahraki M, Ghaderi S (2020). Inequality in distribution of physician and general practitioner in Sistan and Baluchestan province, Iran (2009-2017). Payesh, 19(2):177-86.
31. Anand S, Bärnighausen T(2004). Human resources and health outcomes: cross-country econometric study. Lancet, 364(9445):1603-9.
32. Zandiyan H, Ghiasvand H, Nasimidoost R (2012). Measuring inequality of distribution of health resources A case study. Payesh, 11(6): 799-805.
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Issue | Vol 53 No 5 (2024) | |
Section | Original Article(s) | |
DOI | https://doi.org/10.18502/ijph.v53i5.15597 | |
Keywords | ||
Physicians Doctors Gini coefficient Human development index World countries |
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