摘要：Rural communities in the United States are served by relatively fewer health care professionals than urban or suburban areas. I review the geographic distribution of 6 classes of health professionals and describe the multiple government and private policies and programs intended to affect their geographic distribution. These programs can be classified into 3 categories—coercive, normative, and utilitarian—that characterize the major policy levers used to influence practice location decisions. Health workforce policies must be normative to ensure equity for rural communities, but goals in this area can be achieved only through a balance of utilitarian and coercive mechanisms. THE SALIENT CHARACTERISTIC of the distribution of rural and urban health practitioners is the clustering of practitioners in more urban locales. This situation is most pronounced in the case of specialists, but it applies in many instances to generalists as well. The argument that this constitutes an inequitable distribution of fundamental goods has been described by New-house and colleagues as “conventional wisdom” but also as “generally misguided,” in that it simply reflects rational choices made by practitioners. 1 Economists have viewed the relatively unequal distribution of practitioners as resulting from market forces associated with preference and demand. 1– 3 This argument implies that policies that influence practitioners to locate in less desirable areas are reacting to “market failure.” I describe the rural–urban distribution of selected groups of health professionals and categorize programs that attempt to change these distributions in relation to market orientations.
