Spatial health services research on family medical care in rural areas

Rural areas are confronted with an ageing population and a corresponding increase in the prevalence of multimorbidity. At the same time there has been an absolute and relative decrease in the number of family doctors in such areas.

The distribution and registration of family doctors is regulated by means of so-called requirements planning ("Bedarfsplanung"). This was introduced to prevent a glut of doctors, is based on the number of doctors per head of the population in the 1990s, and has no empirical basis in terms of the quality of provided health care. The planning acts on the territorial level of so-called "Mittelbereiche" that are usually between the sizes of municipalities and districts. Its view is restricted to a global view of the health care situation within a "Mittelbereich" without any critical consideration of the real circumstances. While at a federal state level, a shift in requirements planning has opened up possibilities to deal with these limitations, there is a lack of suitable tools that would enable planning to be carried out more realistically.

It is important to realize that only knowledge of existing catchment areas for practices in rural areas and the determinants of the resulting regional spread will enable realistic planning to be carried out. Now, as in the future, such planning should also take into account the quality of health care and the workload of doctors, as it is to be expected that the supply situation and workload will both change as a result of the closure of practices and demographic developments.

Details on access to health care must also be collected in order to identify vulnerable patient populations and barriers. Access is not only determined by spatial components such as the accessibility and availability of doctors but also by factors like acceptability, acceptance and the affordability of health care. Such factors include the practice's opening times, its facilities, waiting times for an appointment, the agreeability of the practice team, whether the doctor is male or female, as well as cultural, religious and linguistic factors.

Contact person for more information on current projects: Dr. med. Anne Dahlhaus,