Starfield Barbara, Shi Leiyu, Grover Atul, Macinko James
Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
Health Aff (Millwood). 2005 Jan-Jun;Suppl Web Exclusives:W5-97-W5-107. doi: 10.1377/hlthaff.w5.97.
Analyses at the county level show lower mortality rates where there are more primary care physicians, but this is not the case for specialist supply. These findings confirm those of previous studies at the state and other levels. Increasing the supply of specialists will not improve the United States' position in population health relative to other industrialized countries, and it is likely to lead to greater disparities in health status and outcomes. Adverse effects from inappropriate or unnecessary specialist use may be responsible for the absence of relationship between specialist supply and mortality.
县级层面的分析表明,在基层医疗医生数量较多的地区死亡率较低,但专科医生供应情况并非如此。这些发现证实了之前在州及其他层面的研究结果。增加专科医生的供应不会提升美国在人口健康方面相对于其他工业化国家的地位,而且很可能导致健康状况和结果方面更大的差异。专科医生使用不当或不必要可能产生的不利影响或许是专科医生供应与死亡率之间缺乏关联的原因。