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THE SUPPLY OF OUTPATIENT SERVICES AND ITS
GEOGRAPHICAL DISTRIBUTION WITHIN THE REGIONS OF
THE CZECH REPUBLIC
Ing. Jana Rozmarinová
Introduction
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 Healthcare system in the Czech Republic – important part of the
public sector
 Equal quality of care for everyone as an important public policy
goal
 Measuring inequalities - practice that fosters continuous
improvement within health care systems (WHO, OECD)
 Geographical point of view in relation to the political aim
Studies measuring inequalities considering
measuring inequalities in HC supply from the
geographical point of view
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International
 Gini coefficient (e.g. Chang, 1998; Horev, 2004; Jian 2015; Omrani-Khoo,
2013; Mobaraki, 2013; Chen, 2014; Gravelle 2001)
 Robin Hood index (Wilkinson 2000, Inequitable distribution of GP in
Australia)
Czech Republic
 Gini coefficent, Robin Hood index (Dlouhý, 2000)
 Dlouhý (2018) describes possibility of measurement of the geographic
inequality in the case of multiple health resources with the data envelopment
analysis (DEA)
Aim of the paper
 To analyse the differences in supply of the outpatient care and dentist care
among Czechs Regions
 To analyse the activities made by the central government and government of
the regions and health insurance companies
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Methodology
Data
 The data of the location of outpatient practitioners and dentists
 Institute of Health Information and Statistics of the Czech Republic
 Years 2003, 2013
 Outpatient physicians - both those with independent practices and those from
hospital department
 Special care - dentists
Method
 Calculation of the number of physician per 10 000
 Calculation of th measurement of inequality
 Document analysis (regional governments, central government)
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Measurement of the inequalities
 The absolute range and the relative range
 Simple indicators based on the extreme values
 The Gini Coefficient
 originally used for measuring the income inequalities in the society
 approached from the summary of the Lorenz Curve of the income distribution
 The Robin Hood index
 The proportion of the supply (amount of outpatient physicians or amount of
dentist) which is needed to be redistributed so to reach a perfect equality among
the regions. (0 – perfect equality, 1 – perfect inequality))
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Results
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Population 2003 2003 2013 2013 Physicians Dentists
Region 2003 2013 Physicians Dentists Physicians Dentists
Change in
%
Change
in %
Prague 1,161,851 1,244,762 49.37 9.67 59.33 11.66 20.2 20.7
Středočeský 1,131,402 1,297,209 21.57 4.67 21.76 4.77 0.9 2.3
Jihočeský 624,958 636,443 25.55 6.10 29.49 6.43 15.4 5.4
Plzeňský 549,307 572,882 31.11 7.32 32.76 7.38 5.3 0.9
Karlovarský 304,078 300,999 23.58 5.26 27.71 5.68 17.5 8.0
Ústecký 819,851 825,842 23.54 5.07 24.69 5.15 4.9 1.4
Liberecký 427,096 438,473 23.25 5.48 26.36 5.77 13.4 5.3
Královéhradecký 547,720 552,053 28.72 6.46 33.35 7.21 16.1 11.5
Pardubický 506,389 515,781 24.92 5.59 26.64 5.87 6.9 5.1
Vysočina 517,572 510,522 22.30 5.47 24.82 6.17 11.3 12.8
Jihomoravský 1,121,669 1,168,577 30.31 6.78 34.87 7.91 15.0 16.7
Olomoucký 636,227 636,659 28.40 6.52 32.51 7.08 14.5 8.6
Zlínský 592,300 586,594 24.06 6.43 27.96 7.14 16.2 11.0
Moravskoslezský 1,261,229 1,223,923 25.09 5.65 28.59 6.55 13.9 16.1
Czech Republic 10,201,649 10,512,732 27.27 6.18 30.3 6.77 11.1 9.5
Results
Inequality Measure
Physicians
2003 2013
Absolute range 27.8 37.57
Relative Range 1.02 1.22
Robin Hood index (in%) 5.8 6.6
Gini coefficint 0.1102 0.1259
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Results
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Inequality Measure
Dentists
2003 2013
Absolute range 5 6.89
Relative Range 1.00 1.02
Robin Hood index (in %) 7.1 8.2
Gini coefficient 0.0983 0.1832
The institutions and their efforts to a better
geographical distribution of health care services
2017 Ministry of Health of the Czech Republic
 subsidies will be provided to new practitioner od pediatrian in
disadvantages areas
 aim of the program should ensure sufficient availability of dental care in
all regions of the Czech Republic
 list of areas with limited availability of care
2018 Ministry of Health of the Czech Republic
 subsidies will be provided to 100 new dentists
 aim of the program should ensure sufficient availability of dental care in
all regions of the Czech Republic
 list of areas with limited availability of care
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Government of the regions
 The governments of individual regions especially those,
where the care is lacking rarely mention
this problem in their strategic plans.
 The only region Ústecký, emphasizes that the average
number of the outpatient is deeply below the average
values for the Czech Republic.
 Further, the text describes the development of outpatient
health care in the Region as insufficient.
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Conclusion
 The supply of the outpatient is not equally distributed
 We identified the region with the lowest number of the physician
(dentistis)per 10 000 (Středočeský, Vysočina, Liberecký, Ústecký)
 measurement of inequalities shows, that the trend to a higher inequality over
time (2003 – 2013) is increasing
 Measuremetn of inequalities show that the distribution of outpatient care
tends to unequal distribution from 2003 to 2013
 Comparison with previous researech (Dlouhý, the tendency to more
inequitable distribution is emphasized on the data for 1996 and 2002)
 Central government reacts with subsidy provideing in 2017, 2018
 Government regions activities – only Ústecký region describe region´s
dissadvantage in its strategic plans
 Future research challenge – a research to determine implications for health
outcomes
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Thank you for Your attention
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