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How the government intervention affects the distribution of physicians in Turkey between 1965 and 2000
International Journal for Equity in Health
How the government intervention affects the distribution of physicians in Turkey between 1965 and 2000
0 Faculty of Economics and Administrative Sciences, Okan University , Istanbul , Turkey
Introduction: One of the main weaknesses of the health system in Turkey is the uneven distribution of physicians. The diversity among geographical districts was huge in the beginning of the 1960s. After the 1980s, the implementation of a two-year compulsory service for newly graduated physicians is an interesting and specific experience for all countries. The aim of this study is to analyse the distribution of physicians, GPs and specialists between the years 1965-2000 and the efficiency of the strict 15 year government intervention (1981-1995). Methods: The data used in this study includes the published data by the Ministry of Health and The State Institute of Statistics between the years 1965-2000. Covering 35 years for total physicians, GPs and specialists, Gini coefficients are calculated so as to observe the change in the distribution. In order to measure the efficiency of government intervention, Gini index belonging to the previous 15 years (first period-1965 to 1980) and the last 15 years (second period) of 1981 when the compulsory service was enacted is also analysed including the statistical tests. Results: In 1965, the Gini for total physician is quite high (0.47), and in 2000 it decreases considerably (0.20). In 1965, the Gini for GPs and the Gini for specialists is 0.44 and 0.52, respectively and in 2000 these values decrease to 0.13 and 0.28, respectively. It is observed that, with this government intervention, the level of diversity has decreased dramatically up to 2000. Regarding to regression, the rate of decrease in Gini index in the second period is higher for the GPs than that of the specialists. Conclusion: The inequalities in the distribution between GPs and specialists are significantly different; inequality of specialist distribution is higher than the GP. The improvement of the inequality in the physician distribution produced by the market mechanism shows a long period when it is left to its own devices. It is seen that the compulsory service policy is efficient since the physician distribution has improved significantly. The government intervention provides a faster improvement in the GP distribution.
Distribution of physicians; Government intervention on health; Compulsory service for physicians
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Introduction
The unequal distribution of physicians is a fact seen
almost all over the world. The distribution of human
resources in health care has been recognised as one of the
most important issues for the evaluation of persistent
inequities. This problem is not peculiar to Turkey and
could be seen throughout the world as well [1-4]. Any
differences in the distribution of health care personnel
density are seen in various regions of all countries. But
these differences are also seen in the cities of each
region and, moreover, they are also encountered in the
surrounding areas and suburbs of each metropolis [5].
The inequality in distribution of physicians was
generally higher than other health human resources [6]. To
provide a fair distribution of physicians between developed
urban areas and underdeveloped rural areas has been a
continuous effort of the decision-makers of health policy
and practitioners of national health policy in almost all
countries. Planning the geographical distribution of
physicians has been one of the most important policy
implications. Similar to many countries, the problem of arranging
the distribution of physicians with the aim of meeting the
needs of national health organisation and the public
demand have always been on the agenda of the Turkish
governments.
Health services and market failures
Health services used to advance out of the market
mechanism in many ways throughout the world. The
motivations and mechanism of the market cannot provide a
socially efficient production and a fair distribution of the
health services. This means the failure of efficiency and
equity, both of which are expected from an every
economic activity, and the situation that arises when these
two concepts do not happen as expected is the basic
subject of market failures.
Due to the increase in the demand for healthcare in
big cities, employing a greater number of physicians is
an expected case. Demand is not the sole reason of
physician density in big and developed cities/regions.a
The factors affecting the physician distribution are
divided into four categories: (1) supportive facilities; (2)
socioeconomic and demographic characteristics of an
area; (3) socio-cultural considerations; and (4) need for
medical services [7,8].
The market failure argument about the physician
distribution is related to the intensive distribution of
physicians in more advantaged areas. Even though the regions
and cities that could be called more advantaged than
o (...truncated)