Distribution Of Health Care Resources Research Articles

Analyzing the Impact of Decreasing Out-of-Vehicle Time of Public Transportation Travel on Accessibility to Tertiary Hospitals

Unequal distribution of healthcare resources can lead to many fundamental problems, including the accessibility and equity of care in different regions. Existing studies often focus on administrative divisions, street zones, and conducting analyses of healthcare accessibility, but there is a lack of research on healthcare accessibility analysis specifically targeting apartment complexes. Furthermore, there is insufficient consideration of the impact of out-of-vehicle time on healthcare accessibility through public transportation. Taking Beijing’s 5th Ring Road area as an example, we used multiple data sources to construct a framework for the accessibility of medical care in apartment complexes using public transportation. We assumed two scenarios of 1/2 and 1/3 reduction in out-of-vehicle time. We compared and analyzed the changes in accessibility and equity under the two scenarios to investigate the impact of out-of-vehicle time on accessibility and equity of medical care in apartment complexes. The results show that (1) reducing out-of-vehicle time does not guarantee increased accessibility to all apartment complexes. (2) Under both scenarios, the accessibility of most apartment complexes within the fourth and fifth rings increased, and the accessibility of most apartment complexes within the Daxing District increased; otherwise, the accessibility of most apartment complexes in other areas decreased, and the decrease in accessibility was more significant for the scenario with a 1/2 reduction in out-of-vehicle time than for the scenario with a 1/3 reduction in out-of-vehicle time. (3) In both scenarios, the Gini coefficients of residential accessibility were calculated separately for inter-ring and administrative divisions, and the equity of residential accessibility increased in each division; the equity of accessibility increased more with a 1/2 out-of-vehicle time reduction than with a 1/3 out-of-vehicle time reduction. The framework proposed in this paper allows us to analyze the impact of out-of-vehicle time of public transportation on accessibility to medical care for apartment complexes.

Exploring Equity in a Hierarchical Medical Treatment System: A Focus on Determinants of Spatial Accessibility

It is essential to understand the spatial equity of healthcare services to achieve the Sustainable Development Goals. Spatial and non-spatial factors affect access to healthcare, resulting in inequality in the hierarchical medical treatment system. Thus, to provide a comprehensive equity evaluation, it is indispensable to investigate the extent to which spatial accessibility to healthcare services varies due to various factors. This study attempted to analyze the determinants of healthcare accessibility under multi-trip modes and integrate them into Theil index, as a demand index to evaluate spatial equity in the system. The results reveal an inadequate and inequitable distribution of healthcare resources. While access to primary hospitals is limited (47.37% of residential locations cannot access them on foot), 96.58% of residential locations can access general and tertiary hospitals via public transport or driving. Furthermore, inequitable access to the three-tiered medical system was evaluated on a more granular scale, with primary hospitals being closest to achieving equity (inequitable for only 48.83% of residential locations), followed by general and tertiary hospitals (82.01% and 89.20%, respectively). The unequal residential locations brought on by an abundance of medical resources are far from those with a shortage of resources (66.86% > 5.34%). It is thus suggested that services be expanded or resources be transferred to move toward a more equitable system. Our findings provide policymakers with insights into how to increase accessibility to public health.

Causes and Outcomes of Intensive Care Admission Refusals: A Retrospective Audit from a Rural Teaching Hospital in Eastern Cape, South Africa.

(1) Background: Patients who deserve intensive care unit (ICU) admission may be denied due to a lack of resources, complicating ICU triage decisions for intensive care unit (ICU) clinicians. Among the resources that may be unavailable are trained personnel and monitored beds. In South Africa, the distribution of healthcare resources is reflected in the availability of ICU beds, with more ICU beds available in more affluent areas. Data on ICU refusal rates, reasons for refusal, patient characteristics, and outcomes are scarce in resource-constrained rural settings. Hence, this study sheds light on the ICU refusal rates, reasons for refusal, characteristics, and outcomes of refused patients at NMAH. (2) Methods: This was a three-month retrospective cross-sectional record review of refused and admitted patients from January to March 2022. COVID-19 patients and those younger than 13 years old were excluded. Refusal rates, reasons for refusal, characteristics, and outcomes of refused patients were analysed quantitatively using SPSS VS 20 software. Reasons for refusal were categorised as "too well", "too sick", and "suitable for admission but no resources". (3) Results: A total of 135 patients were discussed for ICU admission at NMAH during the study period; 73 (54.07%) were refused admission, and 62 (45.92%) were admitted. Being considered too sick to benefit from ICU was the most common reason for refusal (53.23%). Too well and no resources contributed 27.42% and 19.35%, respectively. Patients with poor functional status, comorbidities, medical diagnoses, and those referred from the ward or accident and emergency unit rather than the operating room were more likely to be refused ICU admission. Refused patients had a seven-day mortality rate of 47%. (4) Conclusions and recommendations: The study found an unmet need for critical care services at our institution, as well as a need for tools to help clinicians make objective triage decisions for critically ill patients. Therefore, the study suggests a need to improve the quality of services provided outside of the ICU, particularly for patients who were refused ICU admission, to improve their outcomes.

A severely fragmented concept: Uncovering citizens’ subjective accounts of severity of illness

Universal healthcare is constrained by national governments' finite health resources. This gives rise to complex priority-setting dilemmas. In several universal healthcare systems, the notion of severity (Norwegian: ‘alvorlighet’) is a key consideration in priority setting, such that treatments for ‘severe’ illness may be prioritised even when evidence suggests it would not be as cost-effective as treatment options for other conditions. However, severity is a poorly-defined concept, and there is no consensus on what severity means in the context of healthcare provision – whether viewed from public, academic, or professional perspectives. Though several public preference-elicitation studies demonstrate that severity is considered relevant in healthcare resource distribution, there is a paucity of research on public perceptions on the actual meaning of severity. We conducted a Q-methodology study between February 2021 and March 2022 to investigate views on severity amongst general public participants in Norway. Group interviews (n = 59) were conducted to gather statements for the Q-sort ranking exercises (n = 34). Data were analysed using by-person factor analysis to identify patterns in the statement rankings. We present a rich picture of perspectives on the term ‘severity’, and identify four different, partly conflicting, views on severity in the Norwegian population, with few areas of consensus. We argue that policymakers ought to be made aware of these differing perspectives on severity, and that there is need for further research on the prevalence of these views and on how they are distributed within populations.

Toward a new model of childhood asthma care: community needs assessment in an underserved urban population

Objectives The objective of this study was to utilize a community-engaged research approach to better understand gaps and opportunities for improving asthma care from the perspectives of patients, caregivers, community organization representatives, and healthcare providers in a predominantly minority community. Methods Forty-one participants from four groups (patients, caregivers, community organization representatives, healthcare providers) participated in interviews or focus groups. A phenomenological approach to this qualitative research allowed the research team to better understand the lived experiences of families seeking asthma care in this community. Results Five gaps and five corresponding opportunities were identified. The gaps identified were unequal healthcare resource distribution; underrepresentation of health professionals from diverse backgrounds; experiences of environmental racism; mistrust, bias, and discrimination in healthcare encounters; and systemic marginalization of communities. The opportunities identified include increasing healthcare infrastructure and accessibility; increasing racially, culturally, and linguistically congruent healthcare; implementing equitable improvements to the built environment; building relationships with communities and individuals; and acknowledging communities’ strengths and resilience. Conclusion This study identified systemic gaps to asthma care that are of prominent concern to the community.

Significance of Hypofractionated Radiotherapy in Postoperative Irradiation for Breast Cancer: An Asian Multi-institutional Prospective Study

AimsThere is a need for the adequate distribution of healthcare resources in Southeast Asia. Many countries in the region have more patients with advanced breast cancer who are eligible for postmastectomy radiotherapy (PMRT). Therefore, it is critical that hypofractionated PMRT is effective in most of these patients. This study investigated the significance of postoperative hypofractionated radiotherapy in patients with breast cancer, including advanced breast cancer, in these countries. Materials and methodsEighteen facilities in 10 Asian countries participated in this prospective, interventional, single-arm study. The study included two independent regimens: hypofractionated whole-breast irradiation (WBI) for patients who had undergone breast-conserving surgery and hypofractionated PMRT for patients who had undergone total mastectomy at a dose of 43.2 Gy in 16 fractions. In the hypofractionated WBI group, patients with high-grade factors received additional 8.1 Gy boost irradiation sessions for the tumour bed in three fractions. ResultsBetween February 2013 and October 2019, 227 and 222 patients were enrolled in the hypofractionated WBI and hypofractionated PMRT groups, respectively. The median follow-up periods in the hypofractionated WBI and hypofractionated PMRT groups were 61 and 60 months, respectively. The 5-year locoregional control rates were 98.9% (95% confidence interval 97.4–100.0) and 96.3% (95% confidence interval 93.2–99.4) in the hypofractionated WBI and hypofractionated PMRT groups, respectively. Regarding adverse events, grade 3 acute dermatitis was observed in 2.2% and 4.9% of patients in the hypofractionated WBI and hypofractionated PMRT groups, respectively. However, no other adverse events were observed. ConclusionAlthough further follow-up is required, hypofractionated radiotherapy regimens for postoperative patients with breast cancer in East and Southeast Asian countries are effective and safe. In particular, the proven efficacy of hypofractionated PMRT indicates that more patients with advanced breast cancer can receive appropriate care in these countries. Hypofractionated WBI and hypofractionated PMRT are reasonable approaches that can contain cancer care costs in these countries. Long-term observation is required to validate our findings.

Analysis of spatial pattern and influencing factors of private clinics in the main urban area of Guiyang in China from 2021 to 2022 based on multi-source data

BackgroundPrivate clinics are important places for residents to obtain daily medical care. However, previous researches mainly focused on public medical institutions but ignored the issue of systematic allocation of social medical resources such as clinics. It is critical to understand the private clinics distribution to analyze the rational allocation of medical resources and the spatial difference.MethodsBased on the field survey, land census, population density, and economic data from Guiyang, this study analyzes the spatial pattern of private clinics in the main urban area of Guiyang and the influencing factors by using spatial analysis methods such as kernel density, standard deviation ellipses, and geo-detector.ResultsThe private clinics in the main urban area of Guiyang are characterized by "inner dense, outer sparse dense," showing an overall spatial clustering feature of "four cores and two belts with many points" and "dense inside and sparse outside." Different types of private clinics have distinct spatial distribution characteristics and agglomeration forms. The growth of private clinics is closely linked to the population growth of mountainous cities. The most important factors influencing the spatial pattern of private clinics are residential land factors, followed by traffic factors and population density. The impact of economic, natural, and spatial factors is minimal. When using a geo-detector, the results of multi-factor interaction differ from those of single factors, and factor interactions have greater explanatory power than single factors in clinic distribution.ConclusionThis study investigates the geographic distribution and influencing variables of private clinics in typical mountain cities and identifies the causes of the current disparity in the distribution of healthcare resources. It is necessary to gradually develop the primary healthcare system in mountainous cities with legislation, counterpart support, and social resources. While ensuring equal access to health care for low-income people and mobile populations, various medical needs of community members should be fully considered and implemented as soon as possible.

Measuring the inequalities in healthcare resource in facility and workforce: A longitudinal study in China.

The study aimed to measure time trends of inequalities of the geographical distribution of health facilities and workforce in Shanghai from 2010 to 2016 and used a spatial autocorrelation analysis method to precisely detect the priority areas for optimizing health resource reallocation in metropolises like Shanghai in developing countries. The study used secondary data from the Shanghai Health Statistical Yearbook and the Shanghai Statistical Yearbook from 2011 to 2017. Five indicators on health resources, namely, health institutions, beds, technicians, doctors, and nurses, were employed to quantitatively measure the healthcare resource in Shanghai. The Theil index and the Gini coefficient were applied to assess the global inequalities in the geographic distribution of these resources in Shanghai. Global and local spatial autocorrelation was performed using global Moran's index and local Moran's index to illustrate the spatial changing patterns and identify the priority areas for two types of healthcare resource allocation. Shanghai's healthcare resources showed decreasing trends of inequalities at large from 2010 to 2016. However, there still existed an unchanged over-concentration distribution in healthcare facilities and workforce density among districts in Shanghai, especially for doctors at the municipal level and facility allocation at the rural level. Through spatial autocorrelation analysis, it was found that there exhibited a significant spatial autocorrelation in the density distribution of all resources, and some identified priority areas were detected for resource re-allocation policy planning. The study identified the existence of inequality in some healthcare resource allocations in Shanghai from 2010 to 2016. Hence, more detailed area-specific healthcare resource planning and distribution policies are required to balance the health workforce distribution at the municipal level and institution distribution at the rural level, and particular geographical areas (low-low and low-high cluster areas) should be focused on and fully considered across all the policies and regional cooperation to ensure health equality for municipal cities like Shanghai in developing countries.

Consumer perceptions of information features in healthcare service advertisements and attitudes toward advertising

Purpose With the increasing dependence on market-based distribution of health-care resources in the USA, spending on health-care service advertisements directly targeting consumers has also increased. Previous research has shown that the ads fail to deliver information deemed essential by regulators. Nevertheless, the attitude of consumers toward health-care service advertising has been more positive than negative. The purpose of this study is to create a taxonomy of advertising information features to better describe the relationships between information features in the advertisements and consumer attitudes toward them. Design/methodology/approach A cross-sectional survey was conducted with 128 health-care consumers in a western state in the USA. Findings Factor analysis generated seven groups of information features. Among them, information features about access, cost and quality of care were rated as most helpful, whereas providers’ clinical qualifications and communication were rated least helpful. The advertising attitude measure was validated to contain two subscales, one regarding health-care service advertising and the other regarding physicians who advertise. People who highly rated the consumerism features had more positive attitudes toward health-care service advertising and people who highly rated provider clinical qualification features had more negative attitudes toward advertising physicians. Originality/value This study made methodological improvements in health-care service advertising research that would be crucial for its theoretical development. It also shed light on consumer characteristics and perceptions about information features that could influence their attitudes toward health-care service advertising.

Below the Surface of Clinical Ethics

AbstractOften lurking below the surface of many clinical ethical issues are questions regarding background metaphysical, epistemological, meta-ethical, and political beliefs. In this issue, authors critically examine the effects of background beliefs on conscientious objection, explore ethical issues through the lenses of particular theoretical approaches like pragmatism and intersectional theory, rigorously explore the basic concepts at play within the patient safety movement, offer new theoretical approaches to old problems involving decision making for patients with dementia, explicate and explore the problems and promises of machine learning in medicine, and offer us a non-rights-based argument for the just distribution of healthcare resources.

The Application of Artificial Intelligence in Health Care Resource Allocation Before and During the COVID-19 Pandemic: Scoping Review

Background Imbalanced health care resource distribution has been central to unequal health outcomes and political tension around the world. Artificial intelligence (AI) has emerged as a promising tool for facilitating resource distribution, especially during emergencies. However, no comprehensive review exists on the use and ethics of AI in health care resource distribution. Objective This study aims to conduct a scoping review of the application of AI in health care resource distribution, and explore the ethical and political issues in such situations. Methods A scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A comprehensive search of relevant literature was conducted in MEDLINE (Ovid), PubMed, Web of Science, and Embase from inception to February 2022. The review included qualitative and quantitative studies investigating the application of AI in health care resource allocation. Results The review involved 22 articles, including 9 on model development and 13 on theoretical discussions, qualitative studies, or review studies. Of the 9 on model development and validation, 5 were conducted in emerging economies, 3 in developed countries, and 1 in a global context. In terms of content, 4 focused on resource distribution at the health system level and 5 focused on resource allocation at the hospital level. Of the 13 qualitative studies, 8 were discussions on the COVID-19 pandemic and the rest were on hospital resources, outbreaks, screening, human resources, and digitalization. Conclusions This scoping review synthesized evidence on AI in health resource distribution, focusing on the COVID-19 pandemic. The results suggest that the application of AI has the potential to improve efficacy in resource distribution, especially during emergencies. Efficient data sharing and collecting structures are needed to make reliable and evidence-based decisions. Health inequality, distributive justice, and transparency must be considered when deploying AI models in real-world situations.

Research progress of integrated traditional Chinese and Western medicine in the treatment of advanced gastric cancer.

Gastric cancer (GC) is a malignant tumor originating from the gastric epithelium, and its incidence and mortality rates rank third among all malignant tumors worldwide. It is also one of the most common cancers in China and is treated predominantly by Western medicine in clinical practice. However, with the advancements in medical technology and informatics, the values of traditional Chinese medicine (TCM) in preventing and treating GC and improving prognosis have increasingly been recognized. According to TCM, clinical manifestations of GC can be divided into Yege (dysphagia), regurgitation, stomach pain, and Zhengxia (abdominal mass). Due to the unbalanced distribution of health care resources in China, most GC patients already have progressive or advanced-stage disease at the first diagnosis. As a result, most GC patients have poor physical function, and surgery or chemotherapy alone will aggravate the impairment to the immune function and seriously affect the quality of life. In contrast, TCM therapies have shown promising efficacy in the management of these patients. Here we review the role of the integrated TCM and Western medicine in treating advanced GC.

Editors’ Introduction

Editors’ Introduction

The impact of the COVID-19 pandemic on catastrophic health expenditure in Greece

<abstract> <p>The measures implemented to combat the coronavirus disease 2019 (COVID-19) adversely affected both the Greek health system and the Greek population. This study aimed to investigate the influence of these measures on the catastrophic health expenditure (CHE) in Greece. The study used data from the household budget surveys (HBSs) of 2019, 2020 and 2021. Two-stage area sampling was applied in all three surveys, with stratification by geographic region and by degree of urbanization, and with samples of n<sub>2019</sub> = 6180, n<sub>2020</sub> = 6256 and n<sub>2021</sub> = 6053. The analysis was based on the fit of two logistic regression models; the incidence of the CHE at the 10% and 25% thresholds was used as outcome variables. The increase in the incidence of the CHE at the 10% threshold during the pandemic was mainly due to the disruption of healthcare delivery, the increase in out-of-pocket (OOP) payments, income losses and the uneven distribution of healthcare resources across the country. Several occupational classes reported a higher CHE than manual workers. Moreover, the deterioration in health was found to contribute to the increase in the incidence of the CHE, while household size protected against the CHE. The latter was also true for the 25% threshold. The results indicated that the pandemic and the associated confinement measures negatively influenced the CHE in Greece.</p> </abstract>

Promoting Equitable Allocation of Medical Therapeutics in the Management of SARS-CoV-2 Patients: A Multi-Tiered Approach

The COVID-19 global pandemic has plagued the world and crippled many economies, taking millions of lives. With the emergence of newer and more potent variants of this virus, it is imperative to remain up to date with novel treatment modalities. Medical therapeutics has been the mainstay treatment and preventive measures used by most nations to prevent widespread disease. With the discovery of oral therapeutics that can reduce the potency of the COVID-19 infection, it is important that we tackle another global health issue – inequitable distribution of healthcare resources. This article aims to address the ethical concerns of allocation of scarce drugs, and a tiered approach to prevent misuse of such oral therapeutics. Scarce resources must be protected and distributed based on a needs basis, to improve healthcare worldwide and alleviate suffering from this pandemic.

MORTALITY RISK BY STATE-LEVEL POVERTY IN COLOMBIA AT DIFFERENT AGE GROUPS

Abstract Residence in high poverty states has been associated with increased mortality risk in the United States, but less attention has been paid to the relationship between state-level poverty and mortality in younger to older adults in Latin America. Poorer states in Colombia, one of the most populous and rapidly aging countries in Latin America, tend to report less access to healthcare, education, and economic opportunities. We examine the relationship between mortality and state-level poverty in Colombia by age and gender. We use data from the 2018 Colombian Census and Vital Statistics to calculate mortality levels and male-female ratios in mortality separately for three broad age categories: young (ages 20-39), middle-aged (40-69), and older adults (70 or older). We find an association between high poverty and high mortality risk among younger men, no association for middle-aged men, and a negative association between mortality risk and poverty among older men. We did not find any evidence for an association between state-level poverty and mortality at any ages. Our results highlight that, for men at older ages, poverty had a counterintuitive association with mortality. These results may be due to selective survival older ages in Colombia or to older adults who are aging into a social safety net that includes healthcare and income benefits. Future research should investigate the impact that unequal access to economic resources and distribution of health care resources has on women and men across age groups in Colombia.

Impact of the increase in the number of community pharmacists on their geographical distribution in Japan: a retrospective survey.

Appropriate distribution of health care resources is required to adjust regional disparities in the quality of health care. Besides, the number of community pharmacists in Japan has increased recently, but the impact of this increase on the distribution of community pharmacists is unknown. Thus, we aimed at investigating the effect of the increase in the number of community pharmacists on the distribution per population and per area of inhabitable land. Data from 2008 to 2018 were used. Equity among municipalities in the number of community pharmacists per population and per area of inhabitable land was assessed using the Gini coefficient. A mosaic plot was used to demonstrate the relationship between the population density and increase in the number of community pharmacists per municipality. The number of community pharmacists increased by approximately 1.3-fold from 2008 to 2018 in Japan. The Gini coefficient per population decreased gradually, whereas that per area increased slightly, with no change in distribution per area of inhabitable land. The number of community pharmacists per population increased regardless of the population density, but this increase per area was smaller for lower population density groups and larger for higher population density groups. The increase in the number of community pharmacists has improved the distribution of community pharmacists per population, but not that per area of inhabitable land. The maldistribution of community pharmacists per area implies an imbalance in the distance between pharmacies and residents. Thus, there is need for measures to improve the distribution of community pharmacists.

Bearing allostatic load: insights into a more equitable future within cardio-oncology.

Chronic stress is often regarded as a significant cause of morbidity and mortality; however, the mechanistic link between stress and various disease states has not yet been fully characterized. We explore the concept of allostatic load, a measurement of the physiological burden of chronic stress, as well as its potential role in disease pathogenesis as it relates to cardiovascular disease, cancer, and health-related disparities. Building from this framework, we then posit the potential implications of allostatic load on patient care and research in cardio-oncology. We identify allostatic load as a potential clinically actionable tool to improve health equity in cardio-oncology.

Characteristics of road traffic mortality and distribution of healthcare resources in Thailand

Road traffic mortalities (RTMs), a leading cause of death globally, mostly occur in low- and middle-income countries, and having sufficient healthcare resources could lower the number of these fatalities. Our study aimed to illustrate the incidence of RTMs per 100,000 population and to compare the distribution of healthcare resources from 2011 to 2021 with rates of RTMs in the 77 provinces of Thailand. We divided the population into adults (≥ 15 years) and children (0–14 years). Lorenz curve and Gini coefficient were used to measure the level of distribution and equality of hospital resources and in relation to RTMs across the country. The average number of deaths was 30.34 per 100,000 per year, with male predominance. The RTM rates for adults and children were 32.71 and 19.08 per 100,000 respectively, and motorcycle accidents accounted for the largest percentage of deaths across all age groups. The Gini coefficient showed that operating rooms (0.42) were the least equally distributed hospital resource, while physicians were the most equally distributed (0.34). Anomalies were identified between the distribution of RTMs and available hospital resources. We hope our study will be beneficial in reallocating these resources more fairly to reflect the different numbers of traffic accidents in each province with the aim of reducing lower traffic-related deaths.

Measuring the geographic disparity of comorbidity in commercially insured individuals compared to the distribution of physicians in South Africa

BackgroundMeasuring and addressing the disparity between access to healthcare resources and underlying health needs of populations is a prominent focus in health policy development. More recently, the fair distribution of healthcare resources among population subgroups have become an important indication of health inequities. Single disease outcomes are commonly used for healthcare resource allocations; however, leveraging population-level comorbidity measures for health disparity research has been limited. This study compares the geographical distribution of comorbidity and associated healthcare utilization among commercially insured individuals in South Africa (SA) relative to the distribution of physicians.MethodsA retrospective, cross-sectional analysis was performed comparing the geographical distribution of comorbidity and physicians for 2.6 million commercially insured individuals over 2016–2017, stratified by geographical districts and population groups in SA. We applied the Johns Hopkins ACG® System across the claims data of a large health plan administrator to measure a comorbidity risk score for each individual. By aggregating individual scores, we determined the average healthcare resource need of individuals per district, known as the comorbidity index (CMI), to describe the disease burden per district. Linear regression models were constructed to test the relationship between CMI, age, gender, population group, and population density against physician density.ResultsOur results showed a tendency for physicians to practice in geographic areas with more insurance enrollees and not necessarily where disease burden may be highest. This was confirmed by a negative relationship between physician density and CMI for the overall population and for three of the four major population groups. Among the population groups, the Black African population had, on average, access to fewer physicians per capita than other population groups, before and after adjusting for confounding factors.ConclusionCMI is a novel measure for healthcare disparities research that considers both acute and chronic conditions contributing to current and future healthcare costs. Our study linked and compared the population-level geographical distribution of CMI to the distribution of physicians using routinely collected data. Our results could provide vital information towards the more equitable distribution of healthcare providers across population groups in SA, and to meet the healthcare needs of disadvantaged communities.