[Analysis of the Association between Regional Deprivation and Utilization: An Assessment of Need for Physicians in Germany]. / Analyse des Zusammenhangs zwischen regionaler Deprivation und Inanspruchnahme ­ Ein Diskussionsbeitrag zur Ermittlung des Arztbedarfes in Deutschland.

ABSTRACT

BACKGROUND: A new strategy for planning outpatient medical care needs to be developed. The social and morbidity structure of the population should be considered in the planning of needs-based provision of medical care. This paper aims to examine the extent to which the degree of regional deprivation can be incorporated in the calculation of the regional requirements for specialists in Germany. METHODS: To measure regional deprivation status at district level, we used the "German Index of Multiple Deprivation" (GIMD) developed in the Helmholtz Zentrum München - German Research Center for Environmental Health. Scores were calculated for the deprivation status of each rural and urban district in Germany. The methods used to compute the deprivation-adjusted medical need are linear regression analyses. The analyses were based on regionalized data for the number of office-based physicians and their billing data. The analyses were carried out with the SPSS software package, version 20. RESULTS: The analyses showed a clear positive correlation between regional deprivation and the utilisation of medical services both for outpatients and in-patients, on the one hand, and mortality and morbidity, as measured by the risk adjustment factor (RSA), on the other. At the district level, the analyses also revealed varying associations between the degree of deprivation and the utilisation of the 12 groups of specialists included in the needs assessment. On this basis, an algorithm was developed by which deprivation at district level can be used to calculate an increase or a decrease in the relative number of specialists needed. DISCUSSION AND CONCLUSION: Using the GIMD and various determinants of medical utilisation, the model showed that medical need increased with the level of regional deprivation. However, regarding SHI medical specialist groups, the associations found in this analysis were statistically (R2) insufficient to suggest a needs assessment planning system based only on the factors analysed, thereby restricting physicians' constitutional right of professional freedom. In particular cases, i. e. licenses to meet special needs, the developed instruments may be suitable for indicating a greater or lesser need for doctors at a regional level due to their relative ease of use and practicability.