Effective instruments for an equitable regional GP distribution – A qualitative comparative analysis on the accessibility to primary care in Europe

Objectives: To explore the effectiveness of different policy instruments in achieving a more equal and equitable regional distribution of primary care supply structures, namely of general practitioners (GPs), in Europe. Four instruments were analyzed regarding their impact on regional GP distribution: 1) Interventions during training phase, 2) Financial and non-financial incentives, 3) Regional restrictions of the number of GPs based on a (needs- or per capita-based) quota, 4) Capitation-based remuneration. Methods: The combined gini coefficient and decile ratio were used to assess the equality and equity of regional GP distribution (NUTS 2 level) for each of the 21 European countries in the sample. An equality indicator was derived by comparing regional number of inhabitants with the regional share of GPs. Equity was measured by a comparison of needs-weighted population and regional GP share. Needs-weighting took into account the regional share of elderly people and the premature mortality rate. A fuzzy-set qualitative comparative analysis (Ragin 2000, 2008) was employed to explore the distributive effectiveness of the four instruments. Results: Needs- or per capita-based quotas determining the regional number of GPs proved to be the most effective instrument for both a high equality and equity of GP distribution. Remunerating GPs largely through capitation payments and offering direct financial incentives to those practicing in remote or rural areas also had a positive, yet weaker effect. Countries using a combination of these instruments demonstrated the highest equity in access to primary care. Discussion: In the light of a decreasing population in rural and remote areas many EU countries have instituted different policies in order to ensure the local accessibility to primary care. Yet the effectiveness of these interventions varies widely. By means of a comparative, quantitative-qualitative approach this study helps to identify best practice instruments.

Literatur: Ragin, Charles C. (2000): Fuzzy-set social science. Chicago: University of Chicago Press.

Ragin, Charles C. (2008): Redesigning social inquiry. Fuzzy sets and beyond. Chicago: University of Chicago Press.

Primary care - health care accessibility - healthcare manpower - regional disparities