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How the government intervention affects the distribution of physicians in Turkey between 1965 and 2000.

Ünal E - Int J Equity Health (2015)

Bottom Line: It is observed that, with this government intervention, the level of diversity has decreased dramatically up to 2000.The inequalities in the distribution between GPs and specialists are significantly different; inequality of specialist distribution is higher than the GP.It is seen that the compulsory service policy is efficient since the physician distribution has improved significantly.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Economics and Administrative Sciences, Okan University, İstanbul, Turkey. erdinc.unal@okan.edu.tr.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Change on the ratios of population to physicians for total (a), GP’s (b) and (c) specialists in regions that have the most and least ratios of population to physicians.
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Fig2: Change on the ratios of population to physicians for total (a), GP’s (b) and (c) specialists in regions that have the most and least ratios of population to physicians.

Mentions: In 1965, the average population to physicians is 2881 in Turkey; the Region 1 has the best ratio with 675 and the Region 12 has the worst ratio with 11471 (approximately 17 times). The new student quotas and number of medical schools were increased in Turkey after 1980’s. While the number of physicians was significantly increasing, compulsory service law was levied at the same period to improve the distribution of physicians. Hence, the ratios of population to physicians (for total, GPs and specialists) decreased dramatically. In the year 2000, the average population to physicians is 792 in Turkey; the Region 7 has the best ratio with 445 and the Region 16 has the worst ratio with 2213 (approximately 5 times) (Table 1 and Figure 2).Table 1


How the government intervention affects the distribution of physicians in Turkey between 1965 and 2000.

Ünal E - Int J Equity Health (2015)

Change on the ratios of population to physicians for total (a), GP’s (b) and (c) specialists in regions that have the most and least ratios of population to physicians.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307150&req=5

Fig2: Change on the ratios of population to physicians for total (a), GP’s (b) and (c) specialists in regions that have the most and least ratios of population to physicians.
Mentions: In 1965, the average population to physicians is 2881 in Turkey; the Region 1 has the best ratio with 675 and the Region 12 has the worst ratio with 11471 (approximately 17 times). The new student quotas and number of medical schools were increased in Turkey after 1980’s. While the number of physicians was significantly increasing, compulsory service law was levied at the same period to improve the distribution of physicians. Hence, the ratios of population to physicians (for total, GPs and specialists) decreased dramatically. In the year 2000, the average population to physicians is 792 in Turkey; the Region 7 has the best ratio with 445 and the Region 16 has the worst ratio with 2213 (approximately 5 times) (Table 1 and Figure 2).Table 1

Bottom Line: It is observed that, with this government intervention, the level of diversity has decreased dramatically up to 2000.The inequalities in the distribution between GPs and specialists are significantly different; inequality of specialist distribution is higher than the GP.It is seen that the compulsory service policy is efficient since the physician distribution has improved significantly.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Economics and Administrative Sciences, Okan University, İstanbul, Turkey. erdinc.unal@okan.edu.tr.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus