Bauer Jan, Müller Peter, Maier Werner, Groneberg David A
Institute of Occupational, Social and Environmental Medicine, Goethe University, Germany.
Public Health Foundation ('Stiftung Gesundheit'), Hamburg, Germany.
PLoS One. 2017 Feb 8;12(2):e0171747. doi: 10.1371/journal.pone.0171747. eCollection 2017.
In Germany, orthopedic workforce planning relies on population-to-provider-ratios represented by the 'official degree of care provision'. However, with geographic information systems (GIS), more sophisticated measurements are available. By utilizing GIS-based technologies we analyzed the current state of demand and supply of the orthopedic workforce in Germany (orthopedic accessibility) with the integrated Floating Catchment Area method. The analysis of n = 153,352,220 distances revealed significant geographical variations on national scale: 5,617,595 people (6.9% of total population) lived in an area with significant low orthopedic accessibility (average z-score = -4.0), whereas 31,748,161 people (39.0% of total population) lived in an area with significant high orthopedic accessibility (average z-score = 8.0). Accessibility was positively correlated with the degree of urbanization (r = 0.49; p<0.001) and the official degree of care provision (r = 0.33; p<0.001) and negatively correlated with regional social deprivation (r = -0.47; p<0.001). Despite advantages of simpler measures regarding implementation and acceptance in health policy, more sophisticated measures of accessibility have the potential to reduce costs as well as improve health care. With this study, significant geographical variations were revealed that show the need to reduce oversupply in less deprived urban areas in order to enable adequate care in more deprived rural areas.
在德国，骨科劳动力规划依赖于由“官方护理提供程度”所代表的人口与提供者比率。然而，借助地理信息系统（GIS），可以获得更精确的衡量标准。通过利用基于GIS的技术，我们采用综合浮动集水区方法分析了德国骨科劳动力的当前供需状况（骨科可及性）。对n = 153,352,220个距离的分析揭示了全国范围内显著的地理差异：5,617,595人（占总人口的6.9%）生活在骨科可及性显著较低的地区（平均z分数 = -4.0），而31,748,161人（占总人口的39.0%）生活在骨科可及性显著较高的地区（平均z分数 = 8.0）。可及性与城市化程度呈正相关（r = 0.49；p<0.001），与官方护理提供程度呈正相关（r = 0.33；p<0.001），与区域社会剥夺呈负相关（r = -0.47；p<0.001）。尽管在卫生政策的实施和接受方面，较简单的衡量标准具有优势，但更精确的可及性衡量标准有可能降低成本并改善医疗保健。通过这项研究，揭示了显著的地理差异，表明有必要减少较不贫困城市地区的供应过剩，以便在更贫困的农村地区提供足够的护理。
