Orthopedic workforce planning in Germany - an analysis of orthopedic accessibility.
In Germany, orthopedic workforce planning relies on population-to-provider-ratios represented by the 'official degree of care provision'. However, with geographic information systems (GIS), more sophisticated measurements are available. By utilizing GIS-based technologies we analyzed the current state of demand and supply of the orthopedic workforce in Germany (orthopedic accessibility) with the integrated Floating Catchment Area method. The analysis of n = 153,352,220 distances revealed significant geographical variations on national scale: 5,617,595 people (6.9% of total population) lived in an area with significant low orthopedic accessibility (average z-score = -4.0), whereas 31,748,161 people (39.0% of total population) lived in an area with significant high orthopedic accessibility (average z-score = 8.0). Accessibility was positively correlated with the degree of urbanization (r = 0.49; p<0.001) and the official degree of care provision (r = 0.33; p<0.001) and negatively correlated with regional social deprivation (r = -0.47; p<0.001). Despite advantages of simpler measures regarding implementation and acceptance in health policy, more sophisticated measures of accessibility have the potential to reduce costs as well as improve health care. With this study, significant geographical variations were revealed that show the need to reduce oversupply in less deprived urban areas in order to enable adequate care in more deprived rural areas.
Institute of Occupational, Social and Environmental Medicine, Goethe University, Germany.
Jan
http://orcid.org/0000-0001-6267-9731
J
Bauer
Public Health Foundation ('Stiftung Gesundheit'), Hamburg, Germany.
Peter
P
Müller
Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, Neuherberg, Germany.
Werner
W
Maier
Institute of Occupational, Social and Environmental Medicine, Goethe University, Germany.
David A
DA
Groneberg
D000465:Algorithms; D005843:Geography; D005858:Germany; D006297:Health Services Accessibility; D006280:Health Workforce; D006801:Humans; D008962:Models, Theoretical; D009985:Orthopedics; D019035:Rural Health Services; D019037:Urban Health Services