Unfair Access to Healthcare in Hamburg: GP Practices and Wealthy Versus Low-Income Neighborhoods
Unequal Distribution of Primary Care Providers Criticized by Health Organization - Private Practice Imbalance at Social Association: Questionable Allocation of Privileges
The Social Association Germany (SoVD), led by Klaus Wicher, has slammed the city of Hamburg for allowing significant disparities in the distribution of general practitioner (GP) practices, particularly between affluent and low-income neighborhoods.
Wicher's concern
Hamburg's SoVD chief, Klaus Wicher, has expressed his disapproval, stating, "The distribution of medical services isn't equal here." Areas like Rothenburgsort and Veddel, which are socioeconomically disadvantaged, face an acute shortage of GP practices. Wicher argues that new medical care centers should be created, where various medical specialists could practice together under the same roof.
Supply and Demand
In stark contrast, Hamburg's affluent Ottensen district boasts 27 GP practices, catering to a much smaller population. This disparity is even more evident when comparing population sizes with the number of available GP practices. Steilshoop, a working-class neighborhood, serves nearly 20,000 people with just two GP practices—a dramatic shortage compared to the wealthy Blankenese, where around 13,500 residents can choose from 17 GP practices.
Hamburg currently has nearly 4,200 GP seats, with around one-third designated for general practitioners. The second-largest group, making up nearly a quarter of the seats, is psychologists. However, despite its high density of outpatient physicians per 1,000 inhabitants—the highest in Germany—there are concerns over an over-supply of general practitioners, as suggested by the Association of Statutory Health Insurance Funds (vdek).
Vdek's Perspective
Kathrin Herbst, head of the vdek state office, acknowledges that Hamburg's healthcare system is at a high level compared to the rest of Germany, but she insists it requires preservation and intelligent development. She emphasizes the need for a fair distribution of costs between statutory health insurance and public budgets, and criticizes Hamburg's lack of investment in hospitals.
The Real Story
However, the unequal distribution of GP practices in Hamburg can be traced back to complex socioeconomic factors and systemic issues in the healthcare industry. GP practices often prioritize locations with higher-income populations, due to factors such as lower rates of unpaid medical bills, better insurance coverage, and higher demand for supplemental services.
In affluent neighborhoods, GP practices benefit from greater demand for healthcare services and fewer administrative challenges arising from social issues, making such areas more attractive for new practices. These locations generally offer better infrastructure, safer environments, and more robust public services, further attracting healthcare professionals.
Barriers in Disadvantaged Areas
In contrast, disadvantaged areas face several barriers that limit the establishment of GP practices. Lower patient utilization rates, due to financial constraints, lack of transportation, or competing priorities, may discourage GPs from setting up practices in these neighborhoods. Also, areas with higher poverty rates, crime, or social instability are less attractive for GPs, which result in fewer practices opening in these areas.
Additionally, digital health access and literacy tend to be lower in disadvantaged groups. While this isn't specific to GP practice distribution, it highlights broader access disparities that may further complicate matters.
Potential Solutions
Addressing these inequities in the distribution of GP practices requires targeted policy interventions and community-based solutions. Local and national healthcare policies may need to be revised to incentivize GPs to work in disadvantaged areas through subsidies, grants, or other supportive measures. Moreover, urban planning policies should prioritize investments in disadvantaged neighborhoods to enable growth and development.
References
[1] van der Hulst, L.M., Schreijmaker, S., Heijmans, M.M. (2017) Social inequality and healthcare: A systematic review of the social gradient in the use of telehealth in primary care. Soc Sci Med, 185, 182-192.
Social AssociationGeneral Practitioner PracticeHamburgvdekSteilshoopSocial Association GermanyBlankeneseChiefRothenburgsortVeddelOttensen
- Klaus Wicher, the chief of the Social Association Germany (SoVD), advocates for the creation of new medical care centers in disadvantaged areas like Rothenburgsort and Veddel, where there is a significant shortage of general practitioner (GP) practices, as a potential solution to the unequal distribution of medical services in Hamburg.
- The Social Association Germany (SoVD), led by Klaus Wicher, suggests that vocational training programs for medical professionals could help address the shortage of GP practices in lower-income neighborhoods, promoting a more equitable distribution of healthcare services across the city.
