What Influences National and Foreign Physicians’ Geographic Distribution? An Analysis of National and International Medical Doctors’ Residence Location in Portugal

Abstract

The debate over physicians’ distribution has attracted the attention of the economic and public health literature over the last forty years. Nonetheless, it is still to date unclear what determines physicians’ location, and whether foreign physicians contribute to fill the geographical gaps left by national doctors in any given country. The present research sets out to investigate the current distribution of national and foreign physicians across Portugal, with the objective to understand its determinants and identify suitable policies to influence it.

Data from the Portuguese National Medical Association on physicians’ residence and characteristics were analysed, as well as data from the National Institute of Statistics on municipalities’ population, living standards and health care network. Descriptive statistics, as well as negative binomial and regression analysis models were adopted to determine: (a) the municipality characteristics predicting Portuguese and International physicians’ geographical distribution, and; (b) the doctors’ characteristics increasing the probability of residing outside the country’s metropolitan areas.

Population, Population’s Purchasing Power, Nurses per capita and Municipality Development Index (MDI) were the municipality characteristics displaying the strongest association with Portuguese physicians’ location. For International physicians, the MDI did not result statistically significant, while municipalities’ proportion of foreign population appeared to be an additional positive factor in their location decisions. In general, being foreigner, male and under-35 resulted to be the physician characteristics increasing the probability of residing outside the metropolitan areas. However, among international doctors, the eldest were more likely to reside outside metropolitan areas, and sex was no longer a significant variable. Belonging to specific nationality groups (like Spanish or Brazilian) was found to increase the probability of being based outside the Lisbon and Oporto metropolitan areas.

The present study showed the relevance of studying the impact of municipality and physicians characteristics on national and international doctors location decisions. A more nuanced understanding of national and foreign doctors’ location appears to be needed to design more effective policies to reduce the unbalance of medical services across geographical areas.

Keywords: Foreign physicians, Portugal, location theory, physician migration, geographical distribution of doctors

JEL Classification: I11, I18