The effects of specialist supply on populations' health: assessing the evidence.
Analyses at the county level show lower mortality rates where there are more primary care physicians, but this is not the case for specialist supply. These findings confirm those of previous studies at the state and other levels. Increasing the supply of specialists will not improve the United States' position in population health relative to other industrialized countries, and it is likely to lead to greater disparities in health status and outcomes. Adverse effects from inappropriate or unnecessary specialist use may be responsible for the absence of relationship between specialist supply and mortality.
Starfield
Barbara
B
Johns Hopkins School of Public Health, Baltimore, Maryland, USA. bstarfie@jhsph.edu
Shi
Leiyu
L
Grover
Atul
A
Macinko
James
J
D019317:Evidence-Based Medicine; D006801:Humans; D008511:Medicine; D009026:Mortality / Q000639:trends*; D013038:Specialization; D014481:United States / Q000453:epidemiology