Kistemann T, Schröer M-A
Institut für Hygiene und Offentliche Gesundheit, Universitätsklinikum Bonn, Bonn. thomas.kistemann@ unibonn.de
Gesundheitswesen. 2007 Nov;69(11):593-600. doi: 10.1055/s-2007-991174.
The aim of this study was to analyse whether geographical disparities exist in the outpatient care within the current planning districts of the German Association of SHI Physicians. Additionally, the motivation for the choice of a specific location by doctors was explored.
The study is based on two methods. Firstly on a geographical-statistical analysis of the ambulatory care in the study district (Rhein-Erft Distric), and secondly on a postal survey of the physicians. From a population of 619 physicians, 210 were chosen through a random sampling and sent a questionnaire. 117 physicians participated in the survey (rate of return: 55.7%).
In the study district a considerable centre-periphery difference exists when considering ambulatory care. Even though the planning district is adequately supplied according to the rules of the German Association of SHI Physicians, there are postcode areas that are undersupplied with physicians. Some of the observed geographical heterogeneities proved to be statistically significant. The postal survey has shown that there are a variety of factors determining the choice of location of physicians. It was not possible to determine whether economic factors play a greater role than soft site-related factors.
The results of the study indicate that the current requirements of the German Association of SHI Physicians are insufficient to solve the problem of grographically equal ambulatory care. Taking into account that economic motives for choice of location are not significant for the physicians on their own, geographical disparities cannot be eliminated by financial incentives only.
本研究旨在分析德国法定医疗保险医师协会当前规划区域内门诊医疗服务是否存在地域差异。此外，还探讨了医生选择特定地点的动机。
该研究基于两种方法。首先，对研究区域（莱茵 - 埃尔夫特县）的门诊医疗服务进行地理统计分析；其次，对医生进行邮政调查。从619名医生的总体中，通过随机抽样选取210名并发送问卷。117名医生参与了调查（回复率：55.7%）。
在研究区域，考虑门诊医疗服务时存在显著的中心 - 周边差异。尽管根据德国法定医疗保险医师协会的规定，规划区域的医疗服务供应充足，但仍有一些邮政编码区域的医生供应不足。一些观察到的地理异质性经统计证明具有显著性。邮政调查表明，有多种因素决定医生的选址。无法确定经济因素是否比与地点相关的软性因素发挥更大作用。
研究结果表明，德国法定医疗保险医师协会目前的要求不足以解决门诊医疗服务地域均等的问题。考虑到选址的经济动机对医生本身并不显著，仅靠经济激励无法消除地域差异。
