Redistributing Health Care Workforce to Addressing Health Service Effectiveness, Efficiency and Equity

Objectives: The United States has the highest health expenditure per capita, yet attains the poorest health outcomes among the Western nations. Taking physician supply in 2006 as an example, the U.S. had a physician-population ratio of 242:100,000, which was well above Japan (209), Canada (215) and the WHO proposed level (100). We understand that differences in health outcomes between Western nations are actually reflective of relative degrees of socio-economic disparities in health in those nations. In this study, we examined the relationship between state density of physicians and other care providers and health outcomes in the U.S. through a socio-geographic lens.

Data Sources: Socio-geographical patterns of practicing care providers in the U.S.--in particular, physicians and non-physician clinicians such as physician assistants (PAs) and nurse practitioners (NPs) --were examined with data from HRSA, the U.S. Census and national databases for non-physician clinicians. Health outcomes were measured by mortality rates from vital statistics.

Findings: We found a tremendous disparity in physician and non-physician clinician population ratios across states, from Mississippi (174 physicians, 3 PAs and 63 NPs) to Massachusetts (405 physicians, 25 PAs and 86 NPs). Among states with higher poverty rates, a majority have densities of practicing physicians and non-physician clinicians that are well below the national average. We further found that a significant shortage of both physicians and PAs were seen in the states with the ten highest mortality rates. In other words, care providers in the U.S. do not proportionally work in those vulnerable areas where populations with poorer health demand additional health care. Conclusions: This study shows that the United States currently maintains a moderate national care provider level, especially when non-physician clinicians are counted. However, physician and non-physician clinician services are maldistributed, away from needs -higher in the economically better off states and lower in the high-poverty states. Since poverty is strongly associated with poor health, the lower care provider numbers in these areas could contribute to the high burden of disease in these states. Our findings indicate an imbalance in the distribution of the health workforce, and the need for policy solutions aimed at incentivizing the redistribution of these resources to address higher needs in high-poverty areas. Otherwise, merely expending national health workforce supply may further widen currently existing health disparities in the country.