Abstract
The federal government passed legislation in the 1960's and 70's to increase physician supplies and reduce spatial inequalities in access to physicians. A major policy was to aggressively continue increasing the overall supply of physicians on the assumption that market forces would eventually divert physicians from areas of high physician density to those of low density. Using state-level, annual data collected over a 21-year period, this paper investigates the macro-scale spatial diffusion of physicians as an essential element in evaluating this policy. The results provide evidence of the policy impacting locational trends relating to primary care physicians, but not specialists. They also indicate that the Medicaid/Medicare programs may have adversely affected the maldistribution problem.
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References
American Medical Association (1968). Reclassification of Physicians, 1968. Chicago Medical Association, 1968.
Belsley, D. A., E. Kuh and R. E. Welsch (1980). Regression Diagnostics: Identifying Influential Data and Sources of Collinearity. New York: John Wiley & Sons.
Brown, D. L. (1974). ‘The Redistribution of Physician and Dentists in Incorporated Places of the Upper Midwest, 1950–1970.’ Rural Sociology 39: 205–223.
Brown, L. J. and J. Reid (1983). ‘Equilibrium and Disequilibrium in Markets for General Practitioners: New Evidence Concerning Geographic Distribution of Physicians.’ Advances in Health Economics and Health Services Research 4: 305–33.
Carbone, R. and R. Longini (1977). ‘A Feedback Approach for Automated Real Estate Assessment,’ Management Science 24: 241–48.
Casetti, E. (1977). ‘Generating Models by the Expansion Method: Applications to Geographic Research,’ Geographical Analysis 4: 81–91.
Champion, D. J. and D. B. Olson (1972). ‘Physician Behavior in Southern Appalachia: Some Recruitment Factors,’ Journal of Health and Social Behavior 12: 245–252.
Coombs, D. W., H. L. Miller and R. W. Roberts (1985). ‘Practice Location Preferences of Alabama Medical Students,’ Journal of Medical Education 60: 697–706.
Cooper, J. K., K. Heald, M. Samuels and S. Coleman (1975). ‘Rural or Urban Practice, Factors Influencing the Location Decision of Primary Care Physicians,’ Inquiry 12: 18–25.
Diseker, R. A. and J. A. Chappell (1976). ‘Relative Importance of Variables in Determination of Practice Location: A Pilot Study,’ Social Science and Medicine 10: 559–563.
Einhorn, H. J. and R. M. Hogarth (1981). ‘Behavioral Decision Theory: Processes of Judgement and Choice,’ Annual Review of Psychology 32: 53–88.
Eisenberg, M. A. and J. R. Cantwell (1976). ‘Policies to Influence the Spatial Distribution of Physicians: A Conceptual Review of Selected Programs and Empirical Evidence,’ Medical Care 14 (June): 455–68.
Ernst, R. L. and D. E. Yett (1985). Physician Location and Specialty Choice, Health Administration Press.
Foster, S. A. (1988). Analyses of the Changing Geographic Distribution of Physicians in the United States from 1950 through 1985. Unpublished Ph.D. Dissertation, Department of Geography, The Ohio State University.
Foster, S. A., W. L. Gorr and F. C. Wimberly (1991). ‘Comparison of Functional and Drift Analysis Approaches to Expansion Modeling: Evaluation of Federal Policies on the Supply of Physicians,’ in E. Casetti and J. P. Jones, III, eds. Applications of the Expansion Method. London: Routledge, pp. 94–114.
Fruen, M. A. and J. R. Cantwell (1982). ‘Geographic Distribution of Physicians: Past Trends and Future Influences,’ Inquiry 19: 44–50.
Ginzberg, E. ed. (1986). From Physician Shortage to Patient Shortage: The Uncertain Future of Medical Practice. Westview.
Golledge, R. G. and H. Timmermans (1990). ‘Applications of Behavioural Research on Spatial Problems I: Cognition.’ Progress in Human Geography 14 (March): 57–99.
Hagerstrand, T. ( 1967). Innovation Diffusion as a Spatial Process. University of Chicago Press.
Lave, J. R., L. B. Lave and S. Leinhardt (1975). ‘Medical Manpower Models: Need, Demand, and Supply.’ Inquiry 12: 97–125.
Mahajan, V., E. Muller and F. M. Bass (1990). ‘Dynamics of Innovation Diffusion: New Product Models in Marketing.’ Journal of Marketing 54: 1–26.
Makridakis, S. and S. C. Wheelwright (1977). ‘Adaptive Filtering: An Integrated Autoregressive/Moving Average Filter for Time Series Forecasting.’ Operations Research Quarterly 28: 425–37.
Parker, R. C. and A. A. Sorensen (1978). ‘The Tide of Rural Physicians: The Ebb and Flow, or Why Physicians Move Out of and Into Small Communities.’ Medical Care 16: 152–166.
Parker, R. C. and A. A. Sorensen (1979). ‘Physician Attitudes Toward Ruiral Practice: Answers and Questions That Were Not Asked.’ Forum on Medicine 2: 411–416.
Parker, R. C. and T. G. Tuxill (1967). ‘The Attitudes of Physicians Toward Small-Community Practice.’ Journal of Medical Education 42: 327–344.
Schwartz, W. B., J. P. Newhouse, B. W. Bennett and A. P. Williams (1980). ‘The Changing Geographic Distribution of Board Certified Physicians.’ New England Journal of Medicine 303: 1032–38.
Starr, P. (1982). The Social Transformation of American Medicine. Basic Books.
Steinwald, B. and C. Steinwald (1975). ‘The Effect of Perceptorship and Rural Training Programs on Physicians' Practice Location Decisions.’ Medical Care 13: 219–229.
Timmermans, H. and R. G. Golledge (1990). ‘Applications of Behavioural Research on Spatial Problems II: Preference and Choice.’ Progress in Human Geography 14: 311–54.
Walker, R. and M. Hannan (1989). ‘Dynamic Settlement Processes: The Case of U.S. Immigration.’ The Professional Geographer 41: 172–83.
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Foster, S.A., Gorr, W.L. Federal health care policy and the geographic diffusion of physicians: A macro-scale analysis. Policy Sci 25, 117–134 (1992). https://doi.org/10.1007/BF00233744
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DOI: https://doi.org/10.1007/BF00233744