Community Health Facilities and Services: The Manpower Dimensions

Abstract

The public believes that economists know that one basic cause of the shortage is the operation of a large collective monopoly that restricts entry into medical practice and enforces price discrimination. But public dissatisfaction with health services would not be eradicated solely by increases of professional numbers. We discuss possible sources of the shortage and how their role might be assessed. Previous research, with a few brilliant exceptions,' slighted the spatial variation in rates of training, practice, and quality of service available across the nation. We have begun analysis of this variation. Our objectives are a better description of this variation and a better understanding of the operation of markets for health services. In a perfectly competitive economy, the judgment that the quantity and distribution of a certain commodity are inadequate can be interpreted to mean that there is a different, better distribution of purchasing power. The judgment is supplied on extra-economic grounds, and the preferred distribution is achieved by ideal taxes and transfers that do not impair optimality. Its consequences are the reallocation of resources to the production of greater quantities of the commodity judged to be deficient, and the reallocation of consumption toward the commodity. Could such a redistribution of income remedy the expressed dissatisfaction with the quantity and distribution of health services? Not entirely, because of the characteristics of the demand for and supply of health services. Many premature deaths and medically unncessarily long illnesses of the poor could have been avoided if they had had greater pur