[Small-scale care by SHI physicians and their subjective choice of location within an oversupplied planning area].
OBJECTIVE
The aim of this study was to analyse whether geographical disparities exist in the outpatient care within the current planning districts of the German Association of SHI Physicians. Additionally, the motivation for the choice of a specific location by doctors was explored.


METHODS
The study is based on two methods. Firstly on a geographical-statistical analysis of the ambulatory care in the study district (Rhein-Erft Distric), and secondly on a postal survey of the physicians. From a population of 619 physicians, 210 were chosen through a random sampling and sent a questionnaire. 117 physicians participated in the survey (rate of return: 55.7%).


RESULTS
In the study district a considerable centre-periphery difference exists when considering ambulatory care. Even though the planning district is adequately supplied according to the rules of the German Association of SHI Physicians, there are postcode areas that are undersupplied with physicians. Some of the observed geographical heterogeneities proved to be statistically significant. The postal survey has shown that there are a variety of factors determining the choice of location of physicians. It was not possible to determine whether economic factors play a greater role than soft site-related factors.


CONCLUSIONS
The results of the study indicate that the current requirements of the German Association of SHI Physicians are insufficient to solve the problem of grographically equal ambulatory care. Taking into account that economic motives for choice of location are not significant for the physicians on their own, geographical disparities cannot be eliminated by financial incentives only.
Kistemann
T
T
Institut für Hygiene und Offentliche Gesundheit, Universitätsklinikum Bonn, Bonn. thomas.kistemann@ unibonn.de
Schröer
M-A
MA
D000553:Ambulatory Care; D002755:Choice Behavior; D018672:Community Health Planning / Q000706:statistics & numerical data; D003284:Contract Services / Q000706:statistics & numerical data*; D005858:Germany; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006302:Health Services Research / Q000706:statistics & numerical data; D006280:Health Workforce; D008507:Medically Underserved Area; D009313:National Health Programs / Q000706:statistics & numerical data*; D011365:Professional Practice Location / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D013038:Specialization