بررسی وضعیت و روند توزیع دندانپزشکان در استان لرستان
محورهای موضوعی : -اقتصاد بهداشت و درمانمریم حسن پور 1 , سجاد قربانی زاده 2 , زهرا اسدی پیری 3 , رسول محمدی 4 , ثریا نورایی مطلق 5
1 - دانشجوی دندانپزشکی، دانشکده دندانپزشکی، دانشگاه علوم پزشکی لرستان، خرم‌آباد، ایران
2 - استادیار، گروه رادیولوژی فک و دهان، دانشکده دندانپزشکی، دانشگاه علوم پزشکی لرستان، خرم‌آباد، ایران
3 - دانشجوی کارشناسی ارشد، گروه علوم مدریت و اقتصاد، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، ایران
4 - استادیار ، گروه اپیدمیولوژی و آمار زیستی، دانشکده بهداشت و تغذیه، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران
5 - استادیار، مرکز عوامل اجتماعی موثر بر سلامت، دانشگاه علوم پزشکی لرستان، خرم‌آباد، ایران
کلید واژه: نیروی انسانی, ضریب جینی, توزیع, دندانپزشکان,
چکیده مقاله :
مقدمه: ارزیابی و سنجش کمیت منابع بخش سلامت و نحوه توزیع در بین مناطق باید به صورت مداوم و پیوسته توسط سیاست‌گذاران و برنامه‌ریزان نظام سلامت صورت گیرد. لذا این مطالعه با هدف بررسی وضعیت و روند نابرابری در توزیع دندانپزشکان شهرستان‌های استان لرستان در دوره زمانی 1390-1398 انجام شد. روش پژوهش: در این مطالعه توصیفی - مقطعی، وضعیت و روند نابرابری در توزیع دندانپزشکان با استفاده از منحنی لورنز و ضریب جینی بررسی گردید. در سال 1398، ضریب جینی توزیع دندانپزشکان شاغل در دانشگاه علوم پزشکی و دندانپزشکان بخش خصوصی نیز مقایسه گردید. کلیه محاسبات با استفاده از نرم‌افزار STATA14 و افزونه dasp در نرم‌افزار استاتا انجام شد. یافته‌ها: یافته‌ها نشان داد در بخش دولتی، شهرستان خرم‌آباد با 4/52 و شهرستان کوهدشت با 1/66 دندانپزشک به ازای صد هزار نفر جمعیت، به ترتیب بیشترین و کمترین تعداد را دارند. شهرستان خرم‌آباد در هر دو بخش دولتی و خصوصی بیشترین تعداد دندانپزشک به ازای صدهزار نفر جمعیت را دارد. مقدار ضریب جینی در بخش دولتی در دوره مورد بررسی از 0/357 در سال 1390 تا 0/56 در سال 1398 متغیر بوده است. مقدار ضریب جینی در دو بخش خصوصی و دولتی به ترتیب برابر 0/53 و 0/567 می‌باشد. نتیجه‌گیری: با توجه به نتایج توزیع دندانپزشکان در استان لرستان در طول سال‌های مورد مطالعه ناعادلانه بوده است. علیرغم افزایش میانگین تعداد دندانپزشکان، نابرابری در توزیع دندانپزشکان روند افزایشی داشته است. بنابراین پیشنهاد می‌گردد سیاست‌های توزیعی اصلاح گردد تا در آینده شاهد کاهش میزان نابرابری و شکاف موجود بین شهرستان ها باشیم.
Introduction: Assessing and quantifying the resources of the health sector and how it is distributed among the regions should be done continuously by policy makers and planners of the health system. Therefore, this study was conducted to investigate the status and trend of inequality in the distribution of dentists in the cities of Lorestan province in the period 2011-2019. Methods: In this descriptive cross-sectional study, the status and trend of inequality in the distribution of dentists were investigated using Lorenz curve and Gini coefficient. In 2011, the Gini coefficient of distribution of dentists working in the University of Medical Sciences and private sector dentists was also compared. Results: The results showed that in the public sector, Khorramabad city with 4.52 and Koohdasht city with 1.66 dentists per 100,000 populations, have the highest and lowest numbers, respectively. Khorramabad city has the highest number of dentists per 100,000 people in both public and private sectors. The Gini coefficient in the public sector in the period under review ranged from 0.357 in 2011 to 0.56 in 1398. The Gini coefficient in both private and public sectors is 0.53 and 0.567, respectively. Conclusion: According to the results of the distribution of dentists in Lorestan province during the years under study has been unfair. Despite the increase in the average number of dentists, inequality in the distribution of dentists has been increasing. Therefore, it is suggested that distribution policies be reformed to reduce inequality and gaps between cities in the future.
1- Mirsaeid Seyed Javad G, Mahya M, Elham H, Hossein DJPS. Human Resources Distribution Among Tehran University Of Medical Sciences Hospitals, 2013;7(5).
2- Milicevic MS, Vasic M, Edwards MJHP. Mapping the governance of human resources for health in Serbia, 2015; 119(12): 1613-20.
3- Reda SF, Reda SM, Thomson WM, Schwendicke FJAjoph. Inequality in utilization of dental services: a systematic review and meta-analysis, 2018; 108(2): e1-e7.
4- Honarmand R, Yandarani M, Ansarifar A, Mansurian M, Niknam A. Inequality in distribution of general physicians in primary health care in bushehr, Iran (2010-2013); 2016.
5- Qingwei F. Research on health human resources of the forest industry region in Heilongjiang province based on SWOT analysis, 2012; 12: 1034-9.
6- Omrani-Khoo H, Lotfi F, Safari H, Jame SZB, Moghri J, Shafii MJIjoph. Equity in distribution of health care resources; assessment of need and access, using three practical indicators, 2013; 42(11): 1299.
7- Rezaei S. Inequality in the geographic distribution of health workers in the public health sector in Iran; 2015.
8- Dussault G, Franceschini MCJHrfh. Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce, 2006; 4(1): 1-16.
9- Agere SJJoSDiA. Issues of equity in and access to health care in Zimbabwe, 1990; 5(1): 31-8.
10- Organization WH. The world health report 2006: working together for health: World Health Organization; 2006.
11- Moghadam MN, Amiresmaili M, Goudarzi R, Amini S, Khosravi SJIjoph. Investigating the appropriateness of admission and hospitalization at a teaching hospital: a case of a developing country, 2017; 46(12): 1720.
12- Fleurbaey M, Schokkaert EJJohe. Unfair inequalities in health and health care, 2009; 28(1): 73-90.
13- Kim SJU, growth. Spatial inequality and economic development: Theories, facts, and policies; 2008: 133-66.
14- Graves N, Halton K, Lairson DJIC, Epidemiology H. Economics and preventing hospital-acquired infection: broadening the perspective, 2007; 28(2): 178-84.
15- Jian J, Jianxiang W, Xiaoyi M, Yuding W, Renyong LJIjoph. Equality of medical health resource allocation in China based on the Gini coefficient method, 2015; 44(4): 445.
16- Speybroeck N, Ebener S, Sousa A, Paraje G, Evans D, Prasad AJGWHO. Inequality in access to human resources for health: measurement issues; 2006: 120-8.
17- Toyabe S-iJIjfeih. Trend in geographic distribution of physicians in Japan, 2009; 8(1): 1-8.
18- Horev T, Pesis-Katz I, Mukamel DBJHp. Trends in geographic disparities in allocation of health care resources in the US, 2004; 68(2): 223-32.
19- Aftab A, Soleimani A, Hassanpour NJJohm. Analysis of the Spatial Distribution and Location of Pharmacies Under Nightly in the Past (Case Study the City of Urmia), 2018; 9(1): 33-45.
20- Kurcz R, Kruger E, Tennant MJCdh. Using GIS to analyse dental practice distribution in Indiana, USA, 2013; 30(3): 155-60.
21- Widström E, Tiira H, Tillberg AJBo. Public dental service personnel facing a major health care reform in Finland, 2019; 5(1): 1-6.
22- Da Li L, XIE YF, Rong SJCJDR. Statistical analysis of current oral health care and dental education resources in China, 2019; 22(1): 37-43.
23- Hjern A, Grindefjord M, Sundberg H, Rosén MJCd, epidemiology o. Social inequality in oral health and use of dental care in Sweden, 2001; 29(3): 74-167.
24- Varenne B, Petersen PE, Fournet F, Msellati P, Gary J, Ouattara S, et al. Illness-related behaviour and utilization of oral health services among adult city-dwellers in Burkina Faso: evidence from a household survey, 2006; 6(1): 1-11.
25- Listl SJJodr. Income-related inequalities in dental service utilization by Europeans aged 50+, 2011; 90(6): 717-23.
26- Listl SJJoEBDP. Countries with public dental care coverage have lower social inequalities in the use of dental services than countries without such coverage, 2015; 15(1): 41-2.
27- Listl SJJodr. Inequalities in dental attendance throughout the life-course, 2012; 91(7_suppl): S91-S7.
28- Thanakanjanaphakdee W, Laohasiriwong W, Puttanapong NJJoIOH. Spatial distribution of dentists in Thailand, 2019; 11(6): 340.
29- Gallagher JE, Hutchinson LJIdj. Analysis of human resources for oral health globally: inequitable distribution, 2018; 68(3): 183-9.
30- Kiadaliri AA, Hosseinpour R, Haghparast-Bidgoli H, Gerdtham U-GJIjoer, health p. Pure and social disparities in distribution of dentists: a cross-sectional province-based study in Iran, 2013; 10(5): 1882-94.
31- Afsahi M, Haghdoost AA, Houshmand B, Dehghani M, Amanpour SJJoOH, Epidemiology O. Dentist to population ratio and geographic distribution of dentists in Iran in 2019, 2021; 10(2): 72-80.
32- Ameryoun A, Meskarpour-Amiri M, Dezfuli-Nejad ML, Khoddami-Vishteh H, Tofighi SJIjoph. The assessment of inequality on geographical distribution of non-cardiac intensive care beds in Iran, 2011; 40(2): 25.
33- Shahabi M, Tofighi S, Maleki MRJJoha. The nurse and specialist physicians manpower distribution by population and its relationship with the number of beds at public hospitals in Iran’s 2001-2006, 2010; 13(41): 7-14.
34- Ramandi SD, Niakan L, Aboutorabi M, Noghabi JJ, Khammarnia M, Sadeghi A. Trend of Inequality in the Distribution of Health Care Resources in Iran. Galen Medical Journal, 2016; 5(3): 122-30.
35- Sefiddashti SE, Arab M, Ghazanfari S, Kazemi Z, Rezaei S, Karyani AK. Trends of geographic inequalities in the distribution of human resources in healthcare system: the case of Iran. Electronic physician, 2016; 8(7): 2607.
36- Karagiannis E, Kovacevic' M. A method to calculate the jackknife variance estimator for the Gini coefficient. Oxford Bulletin of Economics and Statistics, 2000; 62(1): 119-22.
37- Shinjo D, Aramaki T. Geographic distribution of healthcare resources, healthcare service provision, and patient flow in Japan: a cross sectional study. Social science & medicine, 2012; 75(11): 1954-63.
38- Munga MA, Mæstad O. Measuring inequalities in the distribution of health workers: the case of Tanzania. Human resources for health, 2009; 7(1): 1-12.
39- Anyangwe SC, Mtonga C. Inequities in the global health workforce: the greatest impediment to health in sub-Saharan Africa. International journal of environmental research and public health, 2007; 4(2): 93-100.
40- Meshkani Z, Markazi Moghaddam N, Valipouer Yekani N, Nazari H, Moalemi S, Kiyani AA. Inequality in the Distribution of Physicians in the South of Iran. Journal of Health Management & Informatics, 2018; 5(3): 96-103.
41- Rabinowitz HK, Diamond JJ, Markham FW, Rabinowitz C. Long-term retention of graduates from a program to increase the supply of rural family physicians. Academic Medicine, 2005; 80(8): 728.
42- Grobler L, Marais BJ, Mabunda S, Marindi P, Reuter H, Volmink J. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database Syst Rev, 2009; 1(1): 1-25.
43- Karyani AK, Matin BK, Malekian P, Rotvandi DM, Amini S, Delavari S, et al. Preferences of Medical Sciences Students for Work Contracts in Deprived Areas of Iran: A Discrete Choice Experiment Analysis. Risk management and healthcare policy, 2020; 13: 927.
44- Rezaei S, Nouri B. Evaluation of inequalities in the distribution of health resources by Gini coefficient and Lorenz curve: a case study in Kurdistan province from 2006 to 2013. Scientific Journal of Kurdistan University of Medical Sciences, 2016; 20(6): 1-11.
45- Yahyavidizaj J, Arab M, Na'emani F, Emamgjolipour S. Distribution of dentists in public sector and household payments for dental services in Iran. Payesh (Health Monitor), 2020; 19(4): 373-81.
46- Kiadaliri AA, Hosseinpour R, Haghparast-Bidgoli H, Gerdtham U-G. Pure and social disparities in distribution of dentists: a cross-sectional province-based study in Iran. International journal of environmental research and public health, 2013; 10(5): 1882-94.
47- Mehrolhassani M, Khosravi S. Study of geographical inequality trend in distribution of human resources and health facilities in health sector of Iran in past decade. Iranian Journal of Epidemiology, 2018; 13: 27-36.
48- Yang C-H, Huang Y-TA, Hsueh Y-SA. Redistributive effects of the National Health Insurance on physicians in Taiwan: a natural experiment time series study. International journal for equity in health, 2013; 12(1): 1-8.
49- Cheng F-C, Chang JY-F, Lin T-C, Chang W-C, Chang Y-T, Chiang C-P. Dentist manpower development and geographical distribution of dentists in Taiwan. Journal of dental sciences, 2020; 15(2): 121-31.
50- Okawa Y, Hirata S, Okada M, Ishii T. Geographic distribution of dentists in Japan: 1980‐2000. Journal of public health dentistry, 2011; 71(3): 236-40.
51- Kruger E, Tennant M, George R. Application of geographic information systems to the analysis of private dental practices distribution in Western Australia. Rural and Remote Health, 2011; 11(3): 109.
52- Okawa Y, Hirata S. Trends in the geographic distribution of dental clinics in Japan. Community dental health, 2014; 31(1): 62-4.
_||_1- Mirsaeid Seyed Javad G, Mahya M, Elham H, Hossein DJPS. Human Resources Distribution Among Tehran University Of Medical Sciences Hospitals, 2013;7(5).
2- Milicevic MS, Vasic M, Edwards MJHP. Mapping the governance of human resources for health in Serbia, 2015; 119(12): 1613-20.
3- Reda SF, Reda SM, Thomson WM, Schwendicke FJAjoph. Inequality in utilization of dental services: a systematic review and meta-analysis, 2018; 108(2): e1-e7.
4- Honarmand R, Yandarani M, Ansarifar A, Mansurian M, Niknam A. Inequality in distribution of general physicians in primary health care in bushehr, Iran (2010-2013); 2016.
5- Qingwei F. Research on health human resources of the forest industry region in Heilongjiang province based on SWOT analysis, 2012; 12: 1034-9.
6- Omrani-Khoo H, Lotfi F, Safari H, Jame SZB, Moghri J, Shafii MJIjoph. Equity in distribution of health care resources; assessment of need and access, using three practical indicators, 2013; 42(11): 1299.
7- Rezaei S. Inequality in the geographic distribution of health workers in the public health sector in Iran; 2015.
8- Dussault G, Franceschini MCJHrfh. Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce, 2006; 4(1): 1-16.
9- Agere SJJoSDiA. Issues of equity in and access to health care in Zimbabwe, 1990; 5(1): 31-8.
10- Organization WH. The world health report 2006: working together for health: World Health Organization; 2006.
11- Moghadam MN, Amiresmaili M, Goudarzi R, Amini S, Khosravi SJIjoph. Investigating the appropriateness of admission and hospitalization at a teaching hospital: a case of a developing country, 2017; 46(12): 1720.
12- Fleurbaey M, Schokkaert EJJohe. Unfair inequalities in health and health care, 2009; 28(1): 73-90.
13- Kim SJU, growth. Spatial inequality and economic development: Theories, facts, and policies; 2008: 133-66.
14- Graves N, Halton K, Lairson DJIC, Epidemiology H. Economics and preventing hospital-acquired infection: broadening the perspective, 2007; 28(2): 178-84.
15- Jian J, Jianxiang W, Xiaoyi M, Yuding W, Renyong LJIjoph. Equality of medical health resource allocation in China based on the Gini coefficient method, 2015; 44(4): 445.
16- Speybroeck N, Ebener S, Sousa A, Paraje G, Evans D, Prasad AJGWHO. Inequality in access to human resources for health: measurement issues; 2006: 120-8.
17- Toyabe S-iJIjfeih. Trend in geographic distribution of physicians in Japan, 2009; 8(1): 1-8.
18- Horev T, Pesis-Katz I, Mukamel DBJHp. Trends in geographic disparities in allocation of health care resources in the US, 2004; 68(2): 223-32.
19- Aftab A, Soleimani A, Hassanpour NJJohm. Analysis of the Spatial Distribution and Location of Pharmacies Under Nightly in the Past (Case Study the City of Urmia), 2018; 9(1): 33-45.
20- Kurcz R, Kruger E, Tennant MJCdh. Using GIS to analyse dental practice distribution in Indiana, USA, 2013; 30(3): 155-60.
21- Widström E, Tiira H, Tillberg AJBo. Public dental service personnel facing a major health care reform in Finland, 2019; 5(1): 1-6.
22- Da Li L, XIE YF, Rong SJCJDR. Statistical analysis of current oral health care and dental education resources in China, 2019; 22(1): 37-43.
23- Hjern A, Grindefjord M, Sundberg H, Rosén MJCd, epidemiology o. Social inequality in oral health and use of dental care in Sweden, 2001; 29(3): 74-167.
24- Varenne B, Petersen PE, Fournet F, Msellati P, Gary J, Ouattara S, et al. Illness-related behaviour and utilization of oral health services among adult city-dwellers in Burkina Faso: evidence from a household survey, 2006; 6(1): 1-11.
25- Listl SJJodr. Income-related inequalities in dental service utilization by Europeans aged 50+, 2011; 90(6): 717-23.
26- Listl SJJoEBDP. Countries with public dental care coverage have lower social inequalities in the use of dental services than countries without such coverage, 2015; 15(1): 41-2.
27- Listl SJJodr. Inequalities in dental attendance throughout the life-course, 2012; 91(7_suppl): S91-S7.
28- Thanakanjanaphakdee W, Laohasiriwong W, Puttanapong NJJoIOH. Spatial distribution of dentists in Thailand, 2019; 11(6): 340.
29- Gallagher JE, Hutchinson LJIdj. Analysis of human resources for oral health globally: inequitable distribution, 2018; 68(3): 183-9.
30- Kiadaliri AA, Hosseinpour R, Haghparast-Bidgoli H, Gerdtham U-GJIjoer, health p. Pure and social disparities in distribution of dentists: a cross-sectional province-based study in Iran, 2013; 10(5): 1882-94.
31- Afsahi M, Haghdoost AA, Houshmand B, Dehghani M, Amanpour SJJoOH, Epidemiology O. Dentist to population ratio and geographic distribution of dentists in Iran in 2019, 2021; 10(2): 72-80.
32- Ameryoun A, Meskarpour-Amiri M, Dezfuli-Nejad ML, Khoddami-Vishteh H, Tofighi SJIjoph. The assessment of inequality on geographical distribution of non-cardiac intensive care beds in Iran, 2011; 40(2): 25.
33- Shahabi M, Tofighi S, Maleki MRJJoha. The nurse and specialist physicians manpower distribution by population and its relationship with the number of beds at public hospitals in Iran’s 2001-2006, 2010; 13(41): 7-14.
34- Ramandi SD, Niakan L, Aboutorabi M, Noghabi JJ, Khammarnia M, Sadeghi A. Trend of Inequality in the Distribution of Health Care Resources in Iran. Galen Medical Journal, 2016; 5(3): 122-30.
35- Sefiddashti SE, Arab M, Ghazanfari S, Kazemi Z, Rezaei S, Karyani AK. Trends of geographic inequalities in the distribution of human resources in healthcare system: the case of Iran. Electronic physician, 2016; 8(7): 2607.
36- Karagiannis E, Kovacevic' M. A method to calculate the jackknife variance estimator for the Gini coefficient. Oxford Bulletin of Economics and Statistics, 2000; 62(1): 119-22.
37- Shinjo D, Aramaki T. Geographic distribution of healthcare resources, healthcare service provision, and patient flow in Japan: a cross sectional study. Social science & medicine, 2012; 75(11): 1954-63.
38- Munga MA, Mæstad O. Measuring inequalities in the distribution of health workers: the case of Tanzania. Human resources for health, 2009; 7(1): 1-12.
39- Anyangwe SC, Mtonga C. Inequities in the global health workforce: the greatest impediment to health in sub-Saharan Africa. International journal of environmental research and public health, 2007; 4(2): 93-100.
40- Meshkani Z, Markazi Moghaddam N, Valipouer Yekani N, Nazari H, Moalemi S, Kiyani AA. Inequality in the Distribution of Physicians in the South of Iran. Journal of Health Management & Informatics, 2018; 5(3): 96-103.
41- Rabinowitz HK, Diamond JJ, Markham FW, Rabinowitz C. Long-term retention of graduates from a program to increase the supply of rural family physicians. Academic Medicine, 2005; 80(8): 728.
42- Grobler L, Marais BJ, Mabunda S, Marindi P, Reuter H, Volmink J. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database Syst Rev, 2009; 1(1): 1-25.
43- Karyani AK, Matin BK, Malekian P, Rotvandi DM, Amini S, Delavari S, et al. Preferences of Medical Sciences Students for Work Contracts in Deprived Areas of Iran: A Discrete Choice Experiment Analysis. Risk management and healthcare policy, 2020; 13: 927.
44- Rezaei S, Nouri B. Evaluation of inequalities in the distribution of health resources by Gini coefficient and Lorenz curve: a case study in Kurdistan province from 2006 to 2013. Scientific Journal of Kurdistan University of Medical Sciences, 2016; 20(6): 1-11.
45- Yahyavidizaj J, Arab M, Na'emani F, Emamgjolipour S. Distribution of dentists in public sector and household payments for dental services in Iran. Payesh (Health Monitor), 2020; 19(4): 373-81.
46- Kiadaliri AA, Hosseinpour R, Haghparast-Bidgoli H, Gerdtham U-G. Pure and social disparities in distribution of dentists: a cross-sectional province-based study in Iran. International journal of environmental research and public health, 2013; 10(5): 1882-94.
47- Mehrolhassani M, Khosravi S. Study of geographical inequality trend in distribution of human resources and health facilities in health sector of Iran in past decade. Iranian Journal of Epidemiology, 2018; 13: 27-36.
48- Yang C-H, Huang Y-TA, Hsueh Y-SA. Redistributive effects of the National Health Insurance on physicians in Taiwan: a natural experiment time series study. International journal for equity in health, 2013; 12(1): 1-8.
49- Cheng F-C, Chang JY-F, Lin T-C, Chang W-C, Chang Y-T, Chiang C-P. Dentist manpower development and geographical distribution of dentists in Taiwan. Journal of dental sciences, 2020; 15(2): 121-31.
50- Okawa Y, Hirata S, Okada M, Ishii T. Geographic distribution of dentists in Japan: 1980‐2000. Journal of public health dentistry, 2011; 71(3): 236-40.
51- Kruger E, Tennant M, George R. Application of geographic information systems to the analysis of private dental practices distribution in Western Australia. Rural and Remote Health, 2011; 11(3): 109.
52- Okawa Y, Hirata S. Trends in the geographic distribution of dental clinics in Japan. Community dental health, 2014; 31(1): 62-4.