Physician distribution across China's cities: regional variations.

BACKGROUND: Distribution of physicians is a key component of access to health care. Although there is extensive research on urban-rural disparities in physician distribution, limited attention has been directed to the heterogeneity across urban areas. This research depicts variations in physician density across over 600 cities in the context of China's rapid urbanization. METHODS: Data came from National Census Surveys and China statistical yearbooks, 2000-2003, and 2010-2013. Cities were characterized in terms of not only administrative level but also geographic regions and urban agglomerations. We analyzed variations in physician supply by applying generalized estimating equations with an ordinal logistic linking function. RESULTS: Although overall physician density increased between 2003 and 2013, with population and socioeconomic attributes adjusted, physician density declined in urban China. On average, urban districts had a higher physician density than county-level cities, but there were regional variations. Cities in urban agglomerations and those outsides did not differ in physician density. CONCLUSION: Despite the reduced inequality between 2003 and 2013, the growth in physician density did not appear to be commensurate with the changes in population health demand. Assessment in physician distribution needs to take into account heterogeneity in population and socioeconomic characteristics.

Determinants and disparities in access to paediatricians in Poland.

BACKGROUND: The purpose of this study was to identify the factors that determine the differences in the distribution and workload of paediatricians in Poland. This research, specific to conditions found within Poland, will help further advance knowledge in this area. Data were derived from the database of Statistics Poland. The level of convergence of the phenomenon studied was analysed. The paediatricians' accessibility index was ascertained and its spatial diversity examined. The level of correlation of patients treated per paediatrician was analysed in relation to indices of urbanisation, availability of paediatricians and disposable income. RESULTS: A moderate variation of patients treated per paediatrician was found and the conditional convergence of the investigated phenomenon observed. A close negative association between the number of patients treated and access to paediatricians (-0.686, p = 0.005) was revealed. CONCLUSIONS: The research suggests that socioeconomic factors may affect the uneven spatial distribution of the workload of paediatricians in Poland and cause differences between the provinces in the equal access to paediatricians. This research may thus provide implications for policy and practice as well as lead to a better understanding of the problem.

Finding flaws in the spatial distribution of health workforce and its influential factors: An empirical analysis based on Chinese provincial panel data, 2010-2019.

Background: The maldistributions of the health workforce showed great inconsistency when singly measured by population quantity or geographic area in China. Meanwhile, earlier studies mainly employed traditional econometric approaches to investigate determinants for the health workforce, which ignored spillover effects of influential factors on neighboring regions. Therefore, we aimed to analyze health workforce allocation in China from demographic and geographic perspectives simultaneously and then explore the spatial pattern and determinants for health workforce allocation taking account of the spillover effect. Methods: The health resource density index (HRDI) equals the geometric mean of health resources per 1,000 persons and per square kilometer. First, the HRDI of licensed physicians (HRDI_P) and registered nurses (HRDI_N) was calculated for descriptive analysis. Then, global and local Moran's I indices were employed to explore the spatial features and aggregation clusters of the health workforce. Finally, four types of independent variables were selected: supportive resources (bed density and government health expenditure), healthcare need (proportion of the elderly population), socioeconomic factors (urbanization rate and GDP per capita), and sociocultural factors (education expenditure per pupil and park green area per capita), and then the spatial panel econometric model was used to assess direct associations and intra-region spillover effects between independent variables and HRDI_P and HRDI_N. Results: Global Moran's I index of HRDI_P and HRDI_N increased from 0.2136 (P = 0.0070) to 0.2316 (P = 0.0050), and from 0.1645 (P = 0.0120) to 0.2022 (P = 0.0080), respectively. Local Moran's I suggested spatial aggregation clusters of HRDI_P and HRDI_N. For HRDI_P, bed density, government health expenditure, and GDP had significantly positive associations with local HRDI_P, while the proportion of the elderly population and education expenditure showed opposite spillover effects. More precisely, a 1% increase in the proportion of the elderly population would lead to a 0.4098% increase in HRDI_P of neighboring provinces, while a 1% increase in education expenditure leads to a 0.2688% decline in neighboring HRDI_P. For HRDI_N, the urbanization rate, bed density, and government health expenditure exerted significantly positive impacted local HRDI_N. In addition, the spillover effect was more evident in the urbanization rate, with a 1% increase in the urbanization rate relating to 0.9080% growth of HRDI_N of surrounding provinces. Negative spillover effects of education expenditure, government health expenditure, and elderly proportion were observed in neighboring HRDI_N. Conclusion: There were substantial spatial disparities in health workforce distribution in China; moreover, the health workforce showed positive spatial agglomeration with a strengthening tendency in the last decade. In addition, supportive resources, healthcare needs, and socioeconomic and sociocultural factors would affect the health labor configuration not only in a given province but also in its nearby provinces.

Transition to family practice in Turkey.

INTRODUCTION: Turkey's primary health care (PHC) system was established in the beginning of the 1960s and provides preventive and curative basic medical services to the population. This article describes the experience of the Turkish health system, as it tries to adapt to the European health system. It describes the current organization of primary health care and the family medicine model that is in the process of implementation and discusses implications of the transition for family physicians and the challenges faced in meeting the needs for health care staff. In Turkey a trend toward urbanization is evident and more staff positions in rural PHC centers are vacant. Shortages of physicians and an ineffective distribution of doctors are seen as a major problem. Family medicine gained popularity at the beginning of the 1990s, as a specialty with a 3-year postgraduate training program. Medical practitioners who are graduates of a 6-year medical training program and are already working in the PHC system are offered retraining courses. Better working conditions and higher salaries may be important incentives for medical practitioners to sign a contract with the social security institution of Turkey. DISCUSSION: The lack of well-trained primary care staff is an ongoing challenge. Attempts to retrain medical practitioners to act as family physicians show promising results. Shortness of physician and health professionals and lack of time and resources in primary health care are problems to overcome during this process.

Influence of urbanization level and gross domestic product of counties in Croatia on access to health care.

AIM: To examine the association of counties' urbanization level and gross domestic product (GDP) per capita on the access to health care. METHODS: Counties were divided in two groups according to the urbanization level and GDP per capita in purchasing power standards. The number of physicians per 100,000 inhabitants, the number of physicians in hospitals in four basic specialties, physicians' workload, average duration of working week, the average number of insurants per general practice (GP) team, and the number of inhabitants covered by one internal medicine outpatient clinic were compared between predominantly urban and predominantly rural counties and between richer and poorer counties. Our study included only GP teams and outpatient clinics under the contract with the Croatian Institute for Health Insurance. Data on physicians were collected from the Ministry of Health and Social Welfare, the Croatian Institute for Health Insurance, the Croatian Institute for Public Health, and the Croatian Medical Chamber. Data on the contracts with the Croatian Institute for Health Insurance and health care services provided under these contracts were obtained from the database of the Institute, while population and gross domestic product data were obtained from the Database of the Croatian Institute for Statistics. World Health Organization Health for All Database was used for the international comparison of physician's data. RESULTS: There was no significant difference in the total number of physicians per 100,000 inhabitants between predominantly urban and predominantly rural counties (206.9+/-41.0 vs 175.4+/-30.3; P=0.067, t test) nor between richer and poorer counties (194.5+/-49.8 vs 187.7+/-25.3; P=0.703, t test). However, there were significantly fewer GPs per 100,000 inhabitants in rural than urban counties (49.0+/-5.5 vs 56.7+/-4.6; P=0.003, t test). GPs in rural counties had more insurants than those working in urban counties (1.749.8+/-172.8 vs 1.540.7+/-106.3; P=0.004, t test). The working week of specialists in the four observed specialties in hospitals was longer than the recommended 48 hours a week. CONCLUSION: The lack of physicians, especially in primary health care can lead to a reduced access to health care and increased workload of physicians, predominantly in rural counties, regardless of the counties' GDP.

Urbanization in a developing country: city size and population composition.

Reasons for the high correlation between city size and educational attainment in developing countries are explored. "Two explanations are examined. First, the types of goods produced in larger cities require relatively high skill labor inputs. Second, public and perhaps private services demanded by higher skill people are only offered in larger cities. The paper econometrically tests these hypotheses for Brazil, estimating the elasticities of substitution (or typically complementarity) between high and low skill labor and the 'bright lights' effect for high versus low skill labor."

Economic development and urbanisation.

PIP: Trends in urbanization in developing countries are analyzed, with a focus on the causes of rapid urbanization and particularly on the role of the division of labor. The impact of urbanization on the process of economic development is described. The role of government and of urban planning policies is also considered.^ieng

Service employment and population growth in Japan.

PIP: The relationship between activities in the service sector of the economy and urban growth is examined, with emphasis on how service activities are related to the pattern and speed of urban growth. The study is based on an analysis of 1970 Japanese census data for cities in the Chubu region that have more than 50,000 inhabitants.^ieng

Introduction: population migration and urbanization in developing countries.

PIP: This introductory article discusses the correlation between migration and rapid urbanization and growth in the largest cities of the developing world. The topics include the characteristics of urbanization, government policies toward population migration, the change in absolute size of the rural population, and the problems of maintaining megacities. Other articles in this special issue are devoted to urbanization patterns in China, South Africa, Iran, Korea and Taiwan as newly industrialized economies (NIEs), informal sectors in the Philippines and Thailand, and low-income settlements in Bogota, Colombia, and India. It is argued that increased urbanization is produced by natural population growth, the expansion of the urban administrative area, and the in-migration from rural areas. A comparison of urbanization rates of countries by per capita gross national product (GNP) reveals that countries with per capita GNP of under US$2000 have urbanization rates of 10-60%. Rates are under 30% in Africa, the Middle East, South Asia, China, and Indonesia. Rapid urbanization appears to follow the economic growth curve. The rate of urbanization in Latin America is high enough to be comparable to urbanization in Europe and the US. Taiwan and Korea have high rates of urbanization that surpass the rate of industrialization. Thailand and Malaysia have low rates of urbanization compared to the size of their per capita GNP. Urbanization rates under 20% occur in countries without economic development. Rates between 20% and 50% occur in countries with or without industrialization. East Asian urbanization is progressing along with industrialization. Africa and the Middle East have urbanization without industrialization. In 1990 there were 20 developing countries and 5 developed countries with populations over 5 million. In 10 of 87 developing countries rural population declined in absolute size. The author identifies and discusses four patterns of urban growth.^ieng

Migration from rural to urban areas in China.

PIP: During the regime of Mao Zedong the migration of rural population to urban areas was forbidden. In 1982 the people's communes were dissolved creating surplus labor. In 1984 permission was given to peasants to move to towns of 100,000 inhabitants or less. In 1986 the state allocation of jobs and lifetime employment practices were abolished leading to the migration of peasants. Urban population has increased 30-50 million annually since 1985. In 1988-89 urban population consisted of urban registry holders numbering 200 million protected by the government, 100 million new residents unqualified for food rations who had moved into towns of 100,000 population, and the so-called floating population getting no government services numbering about 60-80 million in February 1990. Rural towns grew as a result of promotion of smaller sized cities. In 1983 there were 62,310,000 people in such cities, and by 1984 there were over 134 million mainly in the 15-29 age group. The increasing inflow of population into major cities also occurred in 1984-5 owing to the dissolution of communes. 23 cities with populations over 1 million received 10 million migrants/year, and 50 million migrate to towns and cities every year. In 1988 Shanghai had a mostly male floating population of 2.08 million/year, and Beijing had 1,310,000. This phenomenon led to the emergence of surplus agricultural labor. Village and township enterprises absorbed this surplus: in 1988 there were 18,888,600 such entities employing 95,454,600 people or 23.8% of the labor force. Surplus labor totals 220 million out of 400 million agricultural labor force. The gap between the hinterland and the rich coastal areas with special economic zones is widening, reminiscent of the north-south problem. This phenomenon is the harbinger of the transformation of China into a freer society with higher population mobility.^ieng

[Background and characteristics of migration to urban areas in Java].

PIP: A review of urbanization trends in Java, Indonesia, is presented, with the focus on the background and characteristics of migrants to urban areas. Comparisons are made between the characteristics of laborers in the informal sector (housemaids) and those of factory workers, and between migrants from rural areas and those from other urban areas. (summary in ENG)^ieng

Preliminary discussion on speeding-up urbanization of Shanghai suburbs.

PIP: The key to speeding up the urbanization of Shanghai suburbs lies in a proper and rational guidance or the dispersion and assembly of Shanghai's rural and urban populations. 1st, adjust the industrial structure of the rural labor force and promote a further diversion of labor force. Adjustment should be done in various forms and at various levels: 1) reform the rural economic system, improve the related policies in rural areas, speed up reform of agricultural labor productivity to release more farming labor force; 2) strengthen technical and administrative guidance for the suburban commune and brigade-run industries and improve the labor productivity; and 3) search for new ways to develop the tertiary industry. 2nd, draw up policies and adopt measures to encourage the movement of population from the core city to its suburbs. 3rd, handle properly the relation between the population dispersion from the core city and assembly in its suburbs and set up an appropriate model for the movement of rural and urban populations. 4th, take action to increase step by step the proportion of settled population to the dispersed and assembled rural and urban populations of Shanghai. 5th, give priority to the construction of satellite towns and communal towns to promote the construction and development of the system of Shanghai suburban towns. In construction of communal towns, 1) strengthen leadership and embody the construction in a commune project for a social and economic development, 2) plan the construction well, 3) settle funds properly, and 4) increase facilities and raise the level of modernization.^ieng

Industrial population, gross national product and growth of cities and towns.

PIP: This article, which is translated from the original Chinese, examines whether China's current rate of urbanization is compatible with its economic development objectives. Changes in the level of urbanization from 1949 to 1984 are first reviewed. The author then outlines the growth of the urban labor force and the relationship between urbanization and gross national product. It is concluded that it is in the country's interest to continue to control the rate of urban growth up to the end of this century, in order to ensure that the urban population does not exceed 40 percent of the total population by the year 2000.^ieng

Soft technologies, hard choices.

PIP: In the years since the 1st United Nations conference on science, technology, and development in 1963, technology has come under scrutiny and criticism. The 2nd such UN Conference was held in August 1979 and initiated a reassessment of technological development in all countries. The following problems are not amenable to Western-style technology: 1) unemployment; 2) disparities of wealth both inter- and intracountry; and 3) energy needs. Simple transference of technology from the rich to the poor countries will not create badly needed jobs. That is not to say that much capital-intensive technology, e.g., that used in producing chemical fertilizers, is not useful to developing countries. There is a need to spread capital resources and the benefits therefrom more broadly. For example, in the health field, efforts should be made to meet basic health needs rather than invest in expensive medical technology and high-cost hospitals. All the assumptions of rapid economic development for the less developed countries were made in the era of inexpensive energy sources. There is now a need to develop and use technologies utilizing renewable energy sources. Modern technology seems to be placing a stress on the world's biological systems. Certain technologies may simply be incompatible with the need to sustain the earth and its resources. Government efforts will be needed to supplement market action. A world of diversified technologies is envisioned.^ieng