ArticleInternational journal of health geographics2025
Spatial and temporal disparities in general practitioner provision: a 21-year longitudinal analysis from Lower Saxony, Germany.
Article in International journal of health geographics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- From training to practice: a longitudinal study on the retention and career entry of young general practitioners in Czechia.BMC primary care · 2026Article
- Potentially traumatic life events and mental health conditions. Identifying the role of resilience in a cross-sectional study from Northwestern Germany.International journal of public health · 2026Article
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEquitable access to general practitioner services remains a persistent challenge for health systems and is critical for reducing health inequalities, particularly between urban and rural regions. Understanding the spatial and temporal dynamics of primary care provision is vital for informed healthcare planning and policy.
methodsSpatial and temporal disparities in the supply of general practitioners across Lower Saxony, Germany, were assessed over a 21-year period (2000-2021). Data from the Association of Statutory Health Insurance Physicians and municipal population statistics were used to develop the General Practitioner Regional Index - a composite measure incorporating both the availability and accessibility of general practitioners. Non-parametric statistical tests were applied to identify significant trends at the municipal level.
resultsPronounced geographic inequities in general practitioner supply were identified. More than 40% of the population resides in areas with declining supply, while only 5% experience improvements. Urban centres and their peripheries consistently exhibited higher and mostly stable levels of general practitioner supply. In contrast, rural small towns and villages demonstrated both lower baseline accessibility and more frequent negative trends. The primary driver of supply losses in affected areas was physician retirement, while relocation played a secondary role and typically occurred within similar regional types, thereby limiting redistribution effects.
conclusionsThe results underscore the persistence of urban-rural disparities in general practitioner availability and highlight physician retirements as the principal factor behind declining supply, with limited offsetting effects from physician migration. The findings indicate a need for spatially sensitive, succession-focused workforce strategies and innovative primary care models to mitigate rural undersupply and promote health equity.
trial registrationNot applicable. This study does not report the results of a health care intervention on human participants.
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