Skip to main content
Top
Published in: Human Resources for Health 1/2006

Open Access 01-12-2006 | Research

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

Authors: Pavlos N Theodorakis, Georgios D Mantzavinis, Llukan Rrumbullaku, Christos Lionis, Erik Trell

Published in: Human Resources for Health | Issue 1/2006

Login to get access

Abstract

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.
Appendix
Available only for authorised users
Literature
2.
go back to reference Albanian Health System Reform. Position paper on policy and strategies for the Albanian health sector reform. 1999, Tirana, Ministry of Health of Albania Albanian Health System Reform. Position paper on policy and strategies for the Albanian health sector reform. 1999, Tirana, Ministry of Health of Albania
3.
go back to reference Glaros D, Lionis C, Qiqi H, Theodorakis PN, Trell E: Health care in Albania: what of the future?. Lancet. 2001, 357: 1047-10.1016/S0140-6736(05)71624-X.CrossRefPubMed Glaros D, Lionis C, Qiqi H, Theodorakis PN, Trell E: Health care in Albania: what of the future?. Lancet. 2001, 357: 1047-10.1016/S0140-6736(05)71624-X.CrossRefPubMed
4.
go back to reference Rrumbullaku L, Theodorakis PN, Caca P, Lionis C, Trell E: Medical education in Albania: current situation and perspective, with reference to primary care. Croat Med J. 2002, 43: 50-53.PubMed Rrumbullaku L, Theodorakis PN, Caca P, Lionis C, Trell E: Medical education in Albania: current situation and perspective, with reference to primary care. Croat Med J. 2002, 43: 50-53.PubMed
5.
go back to reference Towards unity for health. 1999, Geneva, World Health Organization Towards unity for health. 1999, Geneva, World Health Organization
6.
go back to reference Gravelle H, Sutton M: Inequality in the geographical distribution of general practitioners in England and Wales 1974-1995. J Health Serv Res Policy. 2001, 6: 6-13. 10.1258/1355819011927143.CrossRefPubMed Gravelle H, Sutton M: Inequality in the geographical distribution of general practitioners in England and Wales 1974-1995. J Health Serv Res Policy. 2001, 6: 6-13. 10.1258/1355819011927143.CrossRefPubMed
7.
go back to reference Mantzavinis G, Theodorakis PN, Lionis C, Trell E: [Geographical inequalities in the distribution of general practitioners in Sweden]. Lakartidningen. 2003, 100: 4294-4297.PubMed Mantzavinis G, Theodorakis PN, Lionis C, Trell E: [Geographical inequalities in the distribution of general practitioners in Sweden]. Lakartidningen. 2003, 100: 4294-4297.PubMed
8.
go back to reference Hann M, Gravelle H: The maldistribution of general practitioners in England and Wales: 1974-2003. Br J Gen Pract. 2004, 54: 894-898.PubMedPubMedCentral Hann M, Gravelle H: The maldistribution of general practitioners in England and Wales: 1974-2003. Br J Gen Pract. 2004, 54: 894-898.PubMedPubMedCentral
9.
go back to reference Rrumbullaku L, Theodorakis PN, Pulluqi P, Lionis C, Trell E: Postgraduate training in family medicine in Albania. Postgrad Med J. 2002, 78: 308-310. 10.1136/pmj.78.919.308.CrossRefPubMedPubMedCentral Rrumbullaku L, Theodorakis PN, Pulluqi P, Lionis C, Trell E: Postgraduate training in family medicine in Albania. Postgrad Med J. 2002, 78: 308-310. 10.1136/pmj.78.919.308.CrossRefPubMedPubMedCentral
10.
go back to reference Demographic Yearbook 1990-1999. 2000, Tirana, Institute of Statistics of Albania (INSTAT) Demographic Yearbook 1990-1999. 2000, Tirana, Institute of Statistics of Albania (INSTAT)
11.
go back to reference Indicators of health 1999-2004. 2005, Tirana, Institute of Statistics of Albania (INSTAT) Indicators of health 1999-2004. 2005, Tirana, Institute of Statistics of Albania (INSTAT)
12.
go back to reference Wilkinson D, Symon B: Inequitable distribution of general practitioners in Australia: estimating need through the Robin Hood Index. Aust N Z J Public Health. 2000, 24: 71-75.CrossRefPubMed Wilkinson D, Symon B: Inequitable distribution of general practitioners in Australia: estimating need through the Robin Hood Index. Aust N Z J Public Health. 2000, 24: 71-75.CrossRefPubMed
13.
go back to reference Johnston G, Wilkinson D: Increasingly inequitable distribution of general practitioners in Australia, 1986-96. Aust N Z J Public Health. 2001, 25: 66-70.CrossRefPubMed Johnston G, Wilkinson D: Increasingly inequitable distribution of general practitioners in Australia, 1986-96. Aust N Z J Public Health. 2001, 25: 66-70.CrossRefPubMed
14.
go back to reference Brown MC: Using Gini-style indices to evaluate the spatial patterns of health practitioners: theoretical considerations and an application based on Alberta data. Soc Sci Med. 1994, 38: 1243-1256. 10.1016/0277-9536(94)90189-9.CrossRefPubMed Brown MC: Using Gini-style indices to evaluate the spatial patterns of health practitioners: theoretical considerations and an application based on Alberta data. Soc Sci Med. 1994, 38: 1243-1256. 10.1016/0277-9536(94)90189-9.CrossRefPubMed
16.
go back to reference Kennedy BP, Kawachi I, Prothrow-Stith D: Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States. Bmj. 1996, 312: 1004-1007.CrossRefPubMedPubMedCentral Kennedy BP, Kawachi I, Prothrow-Stith D: Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States. Bmj. 1996, 312: 1004-1007.CrossRefPubMedPubMedCentral
17.
go back to reference Duclos JY, Araar A, Fortin C: DAD:A software for Distributive Analysis / Analyse Distributive. , MIMAP programme, International Development Research Centre, Government of Canada and CIRPEE, Universite Laval, Version 4.4 Duclos JY, Araar A, Fortin C: DAD:A software for Distributive Analysis / Analyse Distributive. , MIMAP programme, International Development Research Centre, Government of Canada and CIRPEE, Universite Laval, Version 4.4
18.
go back to reference Torrado MP: Growth, poverty and income distribution. Economic Development. 1997, Essex, Addison Wesley Longman, 137-188. 6th Torrado MP: Growth, poverty and income distribution. Economic Development. 1997, Essex, Addison Wesley Longman, 137-188. 6th
19.
go back to reference Horev T, Pesis-Katz I, Mukamel DB: Trends in geographic disparities in allocation of health care resources in the US. Health Policy. 2004, 68: 223-232. 10.1016/j.healthpol.2003.09.011.CrossRefPubMed Horev T, Pesis-Katz I, Mukamel DB: Trends in geographic disparities in allocation of health care resources in the US. Health Policy. 2004, 68: 223-232. 10.1016/j.healthpol.2003.09.011.CrossRefPubMed
20.
go back to reference Kobayashi Y, Takaki H: Geographic distribution of physicians in Japan. Lancet. 1992, 340: 1391-1393. 10.1016/0140-6736(92)92569-2.CrossRefPubMed Kobayashi Y, Takaki H: Geographic distribution of physicians in Japan. Lancet. 1992, 340: 1391-1393. 10.1016/0140-6736(92)92569-2.CrossRefPubMed
21.
go back to reference Theodorakis PN, Mantzavinis GD: Inequalities in the distribution of rural primary care physicians in two remote neighboring prefectures of Greece and Albania. Rural Remote Health. 2005, 5: 457-PubMed Theodorakis PN, Mantzavinis GD: Inequalities in the distribution of rural primary care physicians in two remote neighboring prefectures of Greece and Albania. Rural Remote Health. 2005, 5: 457-PubMed
22.
go back to reference Nishiura H, Barua S, Lawpoolsri S, Kittitrakul C, Leman MM, Maha MS, Muangnoicharoen S: Health inequalities in Thailand: geographic distribution of medical supplies in the provinces. Southeast Asian J Trop Med Public Health. 2004, 35: 735-740.PubMed Nishiura H, Barua S, Lawpoolsri S, Kittitrakul C, Leman MM, Maha MS, Muangnoicharoen S: Health inequalities in Thailand: geographic distribution of medical supplies in the provinces. Southeast Asian J Trop Med Public Health. 2004, 35: 735-740.PubMed
Metadata
Title
Measuring health inequalities in Albania: a focus on the distribution of general practitioners
Authors
Pavlos N Theodorakis
Georgios D Mantzavinis
Llukan Rrumbullaku
Christos Lionis
Erik Trell
Publication date
01-12-2006
Publisher
BioMed Central
Published in
Human Resources for Health / Issue 1/2006
Electronic ISSN: 1478-4491
DOI
https://doi.org/10.1186/1478-4491-4-5

Other articles of this Issue 1/2006

Human Resources for Health 1/2006 Go to the issue