Measuring health inequalities in Albania: a focus on the distribution of general practitioners

BACKGROUND: The health workforce has a dynamically changing nature and the regular documentation of the distribution of health professionals is a persistent policy concern. The aim of the present study was to examine available human medical resources in primary care and identify possible inequalities regarding the distribution of general practitioners in Albania between 2000 and 2004. METHODS: With census data, we investigated the degree of inequality by calculating relative inequality indices. We plotted the Lorenz curves and calculated the Gini, Atkinson and Robin Hood indices and decile ratios, both before and after adjusting for mortality and consultation rates. RESULTS: The Gini index for the distribution of general practitioners in 2000 was 0.154. After adjusting for mortality it was 0.126, while after adjusting for consultation rates it was 0.288. The Robin Hood index for 2000 was 11.2%, which corresponds to 173 general practitioners who should be relocated in order to achieve equality. The corresponding figure after adjusting for mortality was 9.2% (142 general practitioners), while after adjusting for consultation rates the number was 20.6% (315). These figures changed to 6.3% (100), 6.3% (115) and 19.8% (315) in 2004. CONCLUSION: There was a declining trend in the inequality of distribution of general practitioners in Albania between 2000 and 2004. The trend in inequality was apparent irrespective of the relative inequality indicator used. The level of inequality varied depending on the adjustment method used. Reallocation strategies for general practitioners in Albania could be the key in alleviating the inequalities in primary care workforce distribution

INEGALITĂŢI ÎN DISTRIBUŢIA MEDICILOR ȘI ASISTENTELOR MEDICALE, ÎN ALBANIA

CONTEXT: BACKGROUND: The aim of this study was to assess the possible inequalities in the distribution of primary health care (PHC) physicians and nurses in Albania, a transitional country in Southeast Europe. METHODS: Based on the available information from the Albanian Health Insurance Fund, we examined the distribution of PHC physicians in each of the 36 districts of Albania for the period 2000-2011, whereas for the nurses for the period 2007-2011. The inequalities in the distribution of PHC physicians and nurses were assessed by plotting the Lorenz curves.RESULTS: There was evidence of an increasing trend in the inequality of distribution of both PHC physicians and nurses in Albania. The increasing trend was more obvious in the distribution of physicians than in the distribution of nurses.Conclusion: Policymakers in the health care sector should be aware of the need for reallocation strategies for PHC physicians and nurses in Albania as an effective means for reducing inequalities of the health care workforce.Keywords: family physicians, inequalities, Lorenz curves, nurses, primary health care.CONTEXT: Scopul acestui studiu a fost de a identifica și măsura inegalitățile existente în distribuția medicilor și asistentelor medicale din sectorul îngrijirilor primare de sănătate, din Albania, o țară din SE Europei aflată în perioada de tranziție.METODE: Pe baza informațiilor disponibile la nivelul Fondului de Asigurări de Sănătate din Albania, am examinat distribuția medicilor din cele 36 regiuni ale Albaniei, pentru perioada 2000-2001, respectiv distribuția regională a asistentelor medicale, pentru perioada 2007-2011. Inegalitățile în ceea ce privește distribuția medicilor și asistentelor medicale au fost apreciate pe baza curbelor Lorenz.REZULTATE: S-a constatat un trend ascendent în ceea ce privește inegalitățile în distribuția medicilor și asistentelor medicale, în funcție de regiune. Această evoluție în timp a inegalităților a fost mai evidentă în cazul medicilor, comparativ cu evoluția inegalităților constatate în cazul asistentelor medicale.CONCLUZII: Decidenții politici din sectorul îngrijirilor de sănătate din Albania ar trebui să fie conștienți de nevoia de elaborare a unor strategii de realocare în domeniul managementului resurselor umane (personalului medical), strategii care să constituie mijloace eficace de reducere a inegalităților forței de muncă din domeniul îngrijirilor de sănătate.Cuvinte cheie: medici de familie, inegalități, curbe Lorenz, asistente medicale, îngrijiri primare de sănătat

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