Help in Research

[lordoftherings]

Any ideas/links onhow to decrease number of doctors? We have lots of them and very few nurses. So far, there is:
1-regulations to limit practitioners
2-choosing a few graduates
3-accepting the ones graduating in Lebanon(since most of them graduate outside and come to practice here.
4-Decreasing the age of retirement for doctors

Any new ideas , preferably with a reference, are appreciated. I'll probably be posting what I wrote untill now.
regards

[gwiz]

A) Cut doctors' pay.

b) Increase nurses' pay.

[lordoftherings]

thanks gwiz. I must say I finished from the nurses' part, so please focus on doctors' numbers.
I am supposed to evaluate the policies and choose the best ones. The one that you said allows for analysis, since we argue that doctors' incomes are already going down, which would force them to demand what is called"supplier -induced demand", which increases the overall health costs. I will evaluate this policy as such. Thanks again sincerely.

[gwiz]

It may not have been intended that way by the UK government, but something that seems to be having the effect you desire is the amount of paperwork now associated with any medical treatment.

[lordoftherings]

also good. Not to mension the appartments they'll have to rent and the equipment they'll have to buy to open a clinic. All these are added costs.

[lordoftherings]

Gwiz
if you have links to what you said about the papers, please put them so I can reference them. Thanks

[gwiz]

Sorry, no references, just things that have been in the news in the UK over the last year or so.

[lordoftherings]

Its alright. I'll try to locate this. Cheers

[lordoftherings]

Ah, I just had the report of designing an AIDS awareness campaign which I worked out with my group. We got the highest grade on that (A minus). I am very happy that the 4 days tough work payed off. I hope I have the same result in this report.

[lordoftherings]

O.K here is what I have till now. Any comments /criticizing are welcome
1-Title: Lebanon: Limit Your Physicians
2-Table of Contents:
A. Executive Summary:
1- Purpose of the paper: a) Present a contextual analysis of the increase of number of Lebanese physicians
b) Implications of this increase on the economy
c) Proposing solutions to regulate and limit this surplus.

2- Definition of problem: a) Brief overview of physicians’ surplus in numbers and distribution
b) Overview of some consequences
c) Comes mostly from immigrants specializing outside
3- Evaluation of policy alternatives: Pros and cons and choosing from the following:
a) Regulations to decrease number of specialists
b) Decrease the retirement age
c) Screening for the best
e) Encourage physicians who graduate in Lebanon
f) Cut down minimal wages
4- Conclusion and recommendations: Choosing 1-regulations and 2- encouraging physicians who graduate in Lebanon
B. Introduction:
1- Context of policy problem:


3-Executive Summary:
- Purpose of the paper: to present a contextual analysis of the increase of number of physicians in Lebanon, the implications of this increase on the economy and proposing solutions to regulate and limit this surplus.

- Definition and description of the policy problem: there is a 2.1-2.4 physician per 1,000 population, a ratio that is very high. Most of these are specialists. This is causing an increase in the cost of health care and an increase in the jobless rates. Most of this increase comes from immigrants who study abroad, and the area of highest concentration is Beirut.
- Evaluation of policy alternatives: Regulations to decrease number of specialists, decrease the retirement age, screening for the best, encourage physicians who graduate in Lebanon, cut down minimal wages,
- Conclusion and recommendations

4-Introduction:
- context of the policy problem: It is highly observed that the Lebanese culture is a one that looks up to and encourages the job of physicians.
- definition of the policy problem (+ our position): Over the years, there has been a big problem in the number of practicing and registered Lebanese physicians. Indeed, the number of physicians has broken guidelines proposed for the required and needed numbers, leaving on the country the burden of increased jobless rates, health costs, and decreased rates of income of these physicians.
Our idea is that these numbers should be limited using regulatory tools, in collaboration with the government and the private sector.
- statement of intent: Since the government and the private sector aren’t really doing anything to limit these dangerous numbers, it became our concern to propose certain solutions to solve this issue and reduce physicians’ numbers. In this report, I intend to explore the problem behind the increase of physicians supply, providing information about the context of the problem. Moreover, I’ll present the different policies that should be followed, providing case studies when these policies where applied. After evaluating and weighing these policies, I should choose the best ones and recommend them.
- methodology and limitations of the study: The information provided are from reports of the World Bank, and certain researchers that may not be updated. In addition to that, there is a problem of underestimating the real numbers of practicing physicians, since the estimates are those of the Lebanese Order of Physicians in Beirut, which estimate only the number of registered physicians. Another limitation is the difference in other contexts in which the solution policies were applied, and that can’t be probably applied to our Lebanese context. Moreover, it is not possible to quantify precisely the end result of this study, i.e by how much would the policies, if applied, reduce the number of physicians. Among the limitations lies the literature review, which at times shows contradictory data.
-road map of the paper (how the paper is organized): The paper will be organized as follows: first, there is the description of the problem, which speaks about the background (why is there lots of physicians, from where they come, problem within its current policy environment …
5. problem description:-background of the problem-problem within its current policy environment:
The problem is manifested in the registered Lebanese physicians that became nearly 9,500 (World Bank, 1999), making the doctor to patient ratio 2.1-2.4 per 1,000 (World Bank, 1999). A study done in 2002 shows that the ratio has increased to 3.1/1,000 populations, and that the physician to nurse ratio is 5:1 when it should be 2 or 3 physicians to one nurse(Tabbarah, 2002, pp33 & 36), both ratios being among the highest in the world. Moreover, The Order of Physicians of Beirut asserts that since year 1993, the rate of increased supplies of physicians is 9%, which is by far exceeding the population growth rate (1.5-2%/year) (World Bank, 1999). Furthermore, estimates by the Order of Physicians of Beirut issued in the 1999 World Bank report says about the distribution of registered physicians that “About two-thirds of doctors are specialists. Among general practitioners, 60-100 are trained family medicine practitioners. Most general practitioners have no post-graduate training”. Most of these numbers come from the immigrants who study abroad, mostly from Eastern Europe, as the ones who graduate from Lebanon constitute only 38.3% of the total physicians registered (Tabbarah, 2002, 35). Below is a table that summarizes the percentage of physicians in each Mohafaza and their ratio per 1,000 populations:





Distribution of physicians by Mohafazat, November, 1999 (from Tabbarah, 2002, pp 32 & 34)
Mohafazat % of physicians Physicians per 1000 population
Beirut 36.91 1/25
Mt. Lebanon 32.38 1/417
North 11.95 1/661
South 11.66 1/482
Bekaa 7.09 1/665
Total 100.00 1/364
Source: Unpublished data obtained from Beirut Order of Physicians
*Estimated by MADMA based on population distribution (UNDP,1998)
The only let out of physicians is through seeking alternative business (like teaching), retirement, and death (Shipman, Lurie, and Goodman , 2004, p. 435). Of course, traveling is another way to decrease the input, but there are many decentives and troubles facing them. To quote Dr. Kamal M.F. Itani, chief of General Surgery at Veterans Affairs Medical Center in Houston and president of the Houston chapter of the NAAMA: “All immigrants face a lot of difficulties and obstacles in starting their careers here,..Some have visa problems or have to re-do training, or perform extra training to become licensed physicians. It’s no surprise that many got frustrated and went back to their country of origin or changed their careers to stay here” (Tawasha, 2002).
This increase has lead to a low hospital beds to doctor ratio (0.9), and caused the income rates of physicians to decrease (Tabbarah, 2002, p 33). Increased jobless rates among physicians come as a logical issue to worry about. That is, physicians with decreased income should cause the supplier-induced demand, increasing as such the overall health cost. Moreover, increased number of physicians needs more rents, more equipment, and consequentially more resources.


6-policy options
7-conclusion an recommendations (start with important findings- outline practical steps for implementation-final thoughts or concluding remarks