Abstract
The spatial allocation of medical resources is closely related to population health outcomes. Health workforce shortage and maldistribution represent significant challenges for health systems functioning in many countries. Romania registers the lowest physicians per patient ratio in the European Union (EU). Despite the increasing number of medical graduates, shortages have become more critical over the past two decades with both out-migration of health professionals and intra-country disparities between large cities and rural areas or between primary and speciality care. Considering these variances in health workforce supply, it is crucial to identify areas with particularly low human resources. This paper focuses on a critical determinant of geographic access to healthcare, namely the availability of health professionals. We identified and analysed the patterns of physicians’ geographic distribution at the lowest spatial level, pointing out their imbalances and factors interrelated with territorial disparities. Gini coefficient calculation and Moran’s I index provided strong evidence for increasing divergences in this distribution. Furthermore, the analysis of the physician/population ratio spatial patterns revealed two areas of opposite clusters on the west-east axis: one of positive spatial aggregation in the west and one negative in the east. Geographical imbalances in the health workforce distribution have adverse effects, particularly on the public healthcare sector. To address the issue of territorial imbalances, we considered that the maldistribution of physicians is contextually created and might cause several dysfunctions in the healthcare system: normative (the dilemma of dual practising in the public and private sector simultaneously), educational (specialized training, enrolment, and logistics), and social (emigration of physicians and retention policies). Therefore, for the effective functioning of its healthcare system, Romania still needs to implement policies to retain medical graduates and reduce physician outflows. Also, specific strategies regarding the size, structure and distribution of the physician workforce are required to alleviate issues related to access to care.
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Authors Affiliations
Liliana Dumitrache*(1), Mariana Nae (1), Gabriel Simion (1), Cristian Cazacu (1)
(1) University of Bucharest, Bucharest, Romania
* Corresponding author
Email: liliana.dumitrache@unibuc.ro
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