The Spatial Distribution of General Medical Practitioners

Most governments regard the spatial distribution of physicians as sub-optimal, whatever methods of remuneration or health care delivery are used. Explanations of the spatial patterning of medical manpower have invoked economic, sociological and epidemiological concepts, although no satisfactorily unifying theories have been found in the literature. Attempts by governments to influence the distribution of physicians have varied in content; many policies have embodied some form of control or incentive, but others have sought to enhance the natural factors that are believed to attract physicians to undermanned localities.

Post-war policies in the National Health Service for the spatial distribution of general medical practitioners have emphasised the elements of financial incentive and negative control, yet the trends in distribution since 1948 have been fluctuating rather than linearly progressive. The perceived inequity of existing distributional patterns remains a matter of contemporary concern, and the geographical mobility of general practitioners (to the extent that this is known from routinely available statistics) appears to be dysfunctional to a desirable distribution. Analysis of the objectives and contents of the policies reveals a number of conceptual problems and administrative inadequacies.

The most important conceptual problems concern the equity objectives of existing distributional policies, the choice of territorial units in the assessment and control of locational choices, the adequacy of the statistical measures that are traditionally employed as indicators of maldistribution, and the potential ambiguities arising from a failure to distinguish between the adequacy of the aggregate supply of manpower and its distribution. The administrative inadequacies include a disincentive effect inherent in the regulations governing the payment of financial incentives and the inability of routine data sources to permit an on-going surveillance of relevant trends.