Document Type : Original Article
Authors
- . Fahimeh Rabbanikhah
- . Reza Moradi 1
- . Elaheh Mazaheri 2
- . Sara Shahbazi 1
- . Loghman Barzegar 3
- . Ali Kazemi Karyani 3
1 Department of Management and Health Economic, School of Public Health, Tehran University of Medical Science, Tehran, Iran,
2 Department of Medical Information Sciences, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran,
3 Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
Abstract
BACKGROUND: Proper distribution of general practitioners (GPs) is one of the challenges in all
health systems. This study aimed to investigate geographical distribution of GPs in public health
sector in Iran between 2010 and 2016.
METHODS: The study is a descriptive–cross‑sectional study. The population of provinces was
extracted from Iran’s National Statistic Center, while information on GPs was gathered from deputy
of statistic and information technology in Ministry of Health and Medical Education. Data analysis was
carried out using descriptive statistics, Gini coefficient (GC), and by drawing geographical distribution
map of GPs. Data analysis was performed by excel 2013, Stata V.14, and Arc GIS software.
RESULTS: The results of calculating the number of GPs per 100,000 population in Iran showed that,
in year 2010, Chaharmahal and Bakhtiari Province had the highest (10.39) and Alborz Province had
the lowest (0.66) number of per capita GPs. The highest number of GPs per 100,000 population
among Iran’s provinces belonged to Chaharmahal and Bakhtiari (8.97), while the lowest belonged
to Tehran (0.28) in year 2016. The GC was 0.31 in year 2010 and 0.283 for 2011. The lowest GC
belonged to year 2012 (GC = 0.272), while the largest coefficient belonged to year 2016 (0.356).
CONCLUSIONS: According to the results of this study, the distribution of GPs in public health sector
of Iran in between 2010 and 2016 showed inequality. Therefore, along with increasing the number
of GPs working in public health sector, it is necessary to pay attention to their distribution. Further
studies are needed to investigate inequality of GPs within and between the provinces.
Keywords
- Munga MA, Maestad O. Measuring inequalities in the distribution
of health workers: The case of Tanzania. Hum Resour Health
2009;7:4.
2. Williams A, Cookson R. Equity in health. Handbook of Health
Economics. Vol. 1. ELSEVIER. 2000. p. 1863‑910.
3. Pong RW, Pitblado JR. Geographic Distribution of Physicians
in Canada: Beyond How Many and Where. Ottawa:Canadian
Institute for Health Information; 2005.
4. Hadian MN. Factors influencing general practitioner demand and
forecasting the number of general practitioner until 2011. J Econ
Res 2011; 6: 115‑24.
5. Amini N, Yadolahi H, Enanlo S. Ranking of quality of life in
provinces of Iran. J Soc Welfare 2005;5:27‑48.
6. Taati KE, Meshkini A, Khorasani ZD. Distribution of specialists
in public hospitals of Iran. Journal ofhealth information
management. 2012:9(4):548‑557.
7. Goddard M, Gravelle H, Hole A, Marini G. Where did all the GPs
go? Increasing supply and geographical equity in England and
Scotland. J Health Serv Res Policy 2010;15:28‑35. - 8. Mobaraki H, Hassani A, Kashkalani T, Khalilnejad R, Chimeh EE.
Equality in distribution of human resources: The case of Iran’s
ministry of health and medical education. Iran J Public Health
2013;42:161‑5.
9. Toyabe S. Trend in geographic distribution of physicians in Japan.
Int J Equity Health 2009;8:5.
10. Isabel C, Paula V. Geographic distribution of physicians in
Portugal. Eur J Health Econ 2010;11:383‑93.
11. Hagh Doost A, Kamyabi A, Shrafi Asgarabad A, Sadeghirad B,
Shafieian H, Ghasemi S. The geographical distribution of the
medical groups in country and the disparities. J Med Counc
Islamic Republic Iran 2010;28:411‑9.
12. Azizi F. Medical education in the Islamic Republic of Iran: Three
decades of success. Iran J Public Health Suppl 2009;1:19‑26.
13. Marandi SA. The integration of medical education and health care
services in the IR of Iran and its health impacts. Iranian Journal
of Public Health, 2009; 38(Suppl. 1):4‑12.
14. Huang WY, T Chiang. Changing geographic distribution of
physicians in Taiwan. J Med 2001;13:20‑5.
15. Matsumoto M, Inoue K, Bowman R, Noguchi S, Toyokawa S,
Kajii E, et al. Geographical distributions of physicians in Japan and
US: Impact of healthcare system on physician dispersal pattern.
Health Policy 2010;96:255‑61.
16. NomuraK, Inoue S, YanoE. The shortage of pediatrician workforce
in rural areas of Japan. Tohoku J Exp Med 2009;217:299‑305.
17. MatsumotoM, Takeuchi K, Yokobayashi K, Tazuma S. Geographic
maldistribution of physicians in Japan: Increasing the number of
generalists is one solution. J Gen Fam Med 2015;16:260‑4.
18. Ahmed SM, Hossain MA, Rajachowdhury AM, Bhuiya AU. The
health workforce crisis in Bangladesh: Shortage, inappropriate
skill‑mix and inequitable distribution. Hum Resour Health 2011;9:3.
19. Ono T, Schoenstein M, Buchan J. Geographic imbalances in doctor
supply and policy responses. OECD Health Working Papers; 2014.
20. Bellù LG, Liberati P. Charting Income Inequality: The Lorenz
Curve. EASYPOL;November 2005.
21. Rad EH, Karyani AK, Zandian H. Access and necessity for road
emergency sites. Trauma Mon 2017;22:2.
22. Sefiddashti SE, Arab M, Ghazanfari S, Kazemi Z, Rezaei S,
Karyani AK, et al. Trends of geographic inequalities in the
distribution of human resources in healthcare system: The case
of Iran. Electron Physician 2016; 8:2607‑13.
23. Farahani M, Subramanian SV, Canning D. The effect of changes
in health sector resources on infant mortality in the short‑run and
the long‑run: A longitudinal econometric analysis. Soc Sci Med
2009; 68: 1918‑25.
24. Kabene SM, Orchard C, Howard JM, Soriano MA, Leduc R. The
importance of human resources management in health care:
A global context. Hum Resour Health 2006;4:20.
25. Sefiddashti SE, Karyani KA, Ghazanfari S. The disparity in
geographical accessibility to healthcare resources in Iran: The
comparison of two cross‑section. Int J Hum Rights Healthc 2016;
9: 86‑94.
26. Shahabi M, Toufighi S, Maleki MR. The nurse and specialist
physicians manpower distribution by population and its
relationship with the number of beds at public hospitals in Iran’s;
2001‑2006. Journal of Health Administration.2010;13:41.
27. Rezaei S, Karyani AK, Fallah R, Matin BK. Relative inequalities in
geographic distribution of health care resources in Kermanshah
province, Islamic republic of Iran. East Mediterr Health J
2016;22:19‑26.
28. Rezaei SK, Akbari Sari A. Inequality in the geographic distribution
of health workers in the public health sector in Iran. Hakim Health
Syst Res J 2015;18:194‑200.
29. Zandian HH, Ramin N. Measurement of inequality in
distribution of health resources: A case study. Payavard Salamat
2012;11:799‑805.
30. Nasiripour AA, Maleki MR, Tabibi SJ. Factors influence on
geographic distribution of physicians in selected countries & 58;
a review article. J Kermanshah Univ Med Sci 2013;17:600‑10.
31. Rezaei S, Karami MB, Kazemi Karyani A, Pourreza A. Distribution
of physicians and hospital beds based on Gini coefficient and
Lorenz curve: A national survey. Journal of Kermanshah
University of Medical Sciences2016;20: 1.
32. Kobayashi Y, Takaki H. Geographic distribution of physicians in
Japan. Lancet 1992; 340: 1391‑3.
33. Theodorakis PN, Mantzavinis GD, Rrumbullaku L, Lionis C,
Trell E. Measuring health inequalities in Albania: A focus on the
distribution of general practitioners. Hum Resour Health 2006; 4: 5.
34. Horev T, Pesis‑Katz I, Mukamel DB. Trends in geographic
disparities in allocation of health care resources in the US. Health
Policy 2004; 68: 223‑32.
35. Watson CJ. The relationship between physician practice location
and medical school area: An empirical model. Soc Sci Med 1980;
14D: 63‑9.
36. Hosseinpoor AR, Van Doorslaer E, Speybroeck N, Naghavi M,
Mohammad K, Majdzadeh R, et al. Decomposing socioeconomic
inequality in infant mortality in Iran. Int J Epidemiol 2006; 35: 1211‑9.
)