Frenk J, Durán-Arenas L, Vázquez-Segovia A, García C, Vázquez D
Fundación Mexicana para la Salud, Centro de Investigaciones en Salud Pública (CISP), Instituto Nacional de Salud Pública (INSP), México.
Salud Publica Mex. 1995 Jan-Feb;37(1):19-30.
A study was carried out in 1970 on the distribution of medical personnel in Mexico. At that time an unequal distribution of physicians was detected, but not emphasized given the general shortage of physicians in the country. At the present time, the situation has changed. In this article the analysis of the 1990 census data using traditional indicators of availability of physicians in the country, as well as indirect criteria of physician requirements is presented. In the year of reference there were 157,407 physicians in the country, with a national average of 673 persons per physician. The distribution of physicians by state showed a great deal of variation in the number of persons per physician. For example, the state of Chiapas has 1,642 inhabitants per physician, whereas the Federal District has 292. The relation between trained and employed physicians shows another important phenomenon: there is a high percentage of physicians that do not practice clinical medicine (19.4%). Nevertheless, the number of physicians almost tripled the growth experienced by the general population, and important differences among and within states do persist. Furthermore, a new paradoxical effect has emerged, the presence of underemployment and unemployment of physicians, even in communities with greater needs for medical care. This indicates that the strategy of training more physicians has not solved the problems of accessibility and coverage, but in fact has fostered new problems and perhaps greater inequalities.
1970年对墨西哥的医务人员分布情况进行了一项研究。当时发现医生分布不均,但鉴于该国医生普遍短缺,这一情况未受到重视。目前,情况已经发生了变化。本文介绍了利用该国医生可及性的传统指标以及医生需求的间接标准对1990年人口普查数据进行的分析。在参考年份,该国共有157,407名医生,全国平均每673人有一名医生。按州划分的医生分布情况显示,各州每名医生对应的人数差异很大。例如,恰帕斯州每名医生对应1,642名居民,而联邦区每名医生对应292名居民。受过培训的医生与从业医生之间的关系显示出另一个重要现象:有很高比例的医生不从事临床医学工作(19.4%)。然而,医生数量几乎是总人口增长的三倍,州与州之间以及州内的差异依然显著。此外,还出现了一种新的矛盾效应,即即使在医疗需求更大的社区,也存在医生就业不足和失业的情况。这表明培养更多医生的策略并没有解决可及性和覆盖范围的问题,反而实际上引发了新问题,甚至可能加剧了不平等。