Abstract
In Germany, orthopedic workforce planning relies on population-to-provider-ratios represented by the ‘official degree of care provision’. However, with geographic information systems (GIS), more sophisticated measurements are available. By utilizing GIS-based technologies we analyzed the current state of demand and supply of the orthopedic workforce in Germany (orthopedic accessibility) with the integrated Floating Catchment Area method. The analysis of n = 153,352,220 distances revealed significant geographical variations on national scale: 5,617,595 people (6.9% of total population) lived in an area with significant low orthopedic accessibility (average z-score = -4.0), whereas 31,748,161 people (39.0% of total population) lived in an area with significant high orthopedic accessibility (average z-score = 8.0). Accessibility was positively correlated with the degree of urbanization (r = 0.49; p<0.001) and the official degree of care provision (r = 0.33; p<0.001) and negatively correlated with regional social deprivation (r = -0.47; p<0.001). Despite advantages of simpler measures regarding implementation and acceptance in health policy, more sophisticated measures of accessibility have the potential to reduce costs as well as improve health care. With this study, significant geographical variations were revealed that show the need to reduce oversupply in less deprived urban areas in order to enable adequate care in more deprived rural areas.
Highlights
Orthopedics play an important role as health care providers both in hospitals and in practices
It has to be noted that 52 out of 416,887 population locations could not reach an orthopedic within 60min (AI = 0)
With this high resolution analysis of orthopedic accessibility in Germany, significant geographical variations could be revealed on national scale
Summary
Orthopedics play an important role as health care providers both in hospitals and in practices. Access to their specialist input can support primary care management of various diseases such as osteoarthritis or musculoskeletal disorders [1,2,3]. There have been geographical variations shown for primary hip and knee joint replacement, which is often related to osteoarthritis [4]. These geographical variations could be related to a differing access to orthopedic care [5]. Availability (number of health care providers) and accessibility
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