S. Mahmut YARDIM, SARP ÜNER

Türkiye’de hekim dağılımında coğrafi farklılıklar

AMAÇ: Bu çalışmada sağlık insan kaynağı dağılım dengesizliklerinde genellikle göz ardı edilen önemli bir kavram olan hakkaniyet temelinde ve hekim örneğinde Türkiye’deki sağlık insan kaynağı dağılım dengesizliklerinin bazı eşitsizlik göstergeleri kullanılarak gösterilmesi amaçlanmıştır. YÖNTEM: Çalışmada hekim dağılımındaki dengesizlik ve hakkaniyet Lorenz ve konsantrasyon eğrileri ve bu eğrilerden türetilen Gini, konsantrasyon ve Kakwani artan oranlılık endeksleri ile değerlendirilmiştir. Sağlık hizmeti gereksinimini değerlendirmek amacıyla beş yaş altı ölüm sayılarının nüfusa oranları kullanılmıştır. Coğrafi birim olarak il alınmıştır. BULGULAR: İller arasında 2010 yılı toplam hekim sayısı dağılım eşitsizliğini gösteren Gini endeks değeri 0,14 olarak hesaplanmıştır. Hekim yoğunluğu açısından en kötü durumda olan %20’lik grup, toplam hekimlerin %13,6’sına sahipken, 5 yaş altı ölümlerin %32,9’u bu grupta meydana gelmektedir. Buna karşılık hekim sayısı bakımından en iyi %20’lik grupta yer alan illerde hekimlerin %28,0’ı mevcutken, beş yaş altı ölümlerin ise %13,8’i bu grupta gerçekleşmektedir. Beş yaş altı ölümler için Kakwani artan oranlılık endeks değeri -0,34 olarak hesaplanmıştır. SONUÇ: Bu çalışmada sağlık insan kaynağı coğrafik dağılım dengesizliklerinin, Kakwani artan oranlılık endeksi ile hakkaniyet temelinde ölçülerek ortaya konulabileceği gösterilmiştir. Sağlık insan kaynağı dağılımının planlanmasında sadece nüfus başına yoğunluğun değil, farklı hizmet ihtiyacı göstergelerinin de göz önüne alınarak, elde edilecek gelişmenin bu çalışmada kullanılan yöntemlerle izlenmesinin yararlı olacağı düşünülmektedir.

Geographical disparities in the distribution of physicians in Turkey

AIM: In this study, it was aimed to demonstrate the geographic imbalances of human resources for health of Turkey, in the case of physicians by using some inequality indicators emphasizing the generally neglected concept; equity. METHOD: Inequality in geographic distribution of physicians and equity was evaluated by using Lorenz and concentration curves and Gini and Gini based indices. Under-five mortality per population was used as a proxy indicator for the health care need of the population. Geographic units were the provinces of Turkey. RESULTS: Gini Index for the physician distribution among the provinces in 2010 was calculated as 0.14. Ranking the population from the lowest through the highest physician density, the first quintile of the population had 13.6% of the total physicians; in contrast they had 32.9% of under-five deaths. The fifth quintile had 28.0% of physicians but they had only 13.8% of under-five deaths. Kakwani Progressivity Index for under-five deaths was -0.34. CONCLUSION: This study showed that the geographic distributional disparities can be quantified by using Kakwani Progressivity Index on an equitable basis. Not only the health manpower density but also the different health care need indicators should be taken into account in the planning of human resources for health and the achievements should be monitored by the methods used in this study.

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