Introduction The big business of health care is growing in a massive rate more now than ever according to The Center for Health Workforce Studies a non-profit organization located in Rensselaer, New York the organization report that, “While total U.S. employment dropped by over 2% between 2000 and 2010, health care employment grew by more than 25% during the same period. More than 13% of the U.S. labor force worked in the health sector or in a health occupation (19 million jobs out of 143 million jobs in U.S. labor force). The health care sector is projected to add over 4.2 million jobs between 2010 and 2020, with 63% of those in ambulatory settings (offices of health practitioners, home health, and other non-institutional settings” (2012, CHWS). Health care is booming in all areas of study and research from Holistic to Western Medicine which include purchasing and supply. Unfortunately this is based off the demand for more Physicians that are not available where there is a need. The health care industry believe it or not includes the food industry and health and fitness as well. The matter of ethics within the health care industry always needs to be address along with the quality of care for patients. Within this working essay paper I will discuss the matter of; Care & Service Provider, Ethics (codes and values), Mal-Distribution Physician Labor Forces. Even though the health care industry is growing the mal-distribution of health care is still evident in some rural areas. This factor of not having proper care delivered to impoverish neighborhoods and communities is another issue that still plagues the United States. David Cutler the online journal reporter for PBS News Hour stated, “About 10, 15 percent. Just to give you one example, Duke University Hospital has 900 hospital beds and 1,300 billing clerks. The typical Canadian hospital has a handful of billing clerks. Single-payer systems have fewer administrative needs. That’s not to say they’re better, but that’s just on one dimension that they clearly cost less. What a lot of those people are doing in America is they are figuring out how to bill different insurers for different systems, figuring out how to collect money from people, all of that sort of stuff” (2013). The need for health care workers is great, but the balance is off regarding where the needs are not being meet.

1. Running Head: DISTRIBUTION OF HEALTH CARE 1
DISTRIBUTION OF HEALTH CARE
GEOGRAPHIC MALDISTRIBUTION OF THE PHYSCIAN
LABOR FORCE
BY: TUNISIA I.E. AL-SALAHUDDIN RMT/BSHS/MS
MARCH 22, 2016
MASTER- HEALTHCARE ADMINISTRATION AND
MANAGEMENT
COLORADO STATE UNIVERSITY-GLOBAL CAMPUS
PROFESSOR: EARL GREENIA, PH.D., FACHE, UNERGRADUATE
AND GRADUATE ADJUNCT FACULTY AT COLORADO STATE
UNIVERSITY GLOBAL CAMPUS
 Care and Service
Providers
 Ethics (codes and
values)
 Mal-distribution of
PhysicianLabor
Forces
Abstract:
The business of distribution
of Health Care goes across
the board into an array of
diverse functions,
departments, physicians,
and supply chains. Even
though the distribution is
wide spread the issue of
ethics and ethical values
need to still be addressed to
ensure the quality of care is
still available for the patient.
Quality of care comes from
the facilities and the
physicians and governed by
ethical codes and values.
Within this working paper
these topics will be
addressed.

2. DISTRIBUTION OF HEALTH CARE 2
Table of Contents
Introduction Pg. 3
Care and Service Providers Pg. 4
Mal-distribution of Physician Labor Forces Pg. 5
Ethics (codes and values) Pg. 6
Conclusion Pg. 7
Reference Pg. 9

3. DISTRIBUTION OF HEALTH CARE 3
Introduction
The big business of health care is growing in a massive rate more now than ever according to The Center
for Health Workforce Studies a non-profit organization located in Rensselaer, New York the organization
report that, “While total U.S. employment dropped by over 2% between 2000 and 2010, health care
employment grew by more than 25% during the same period. More than 13% of the U.S. labor force worked
in the health sector or in a health occupation (19 million jobs out of 143 million jobs in U.S. labor force). The
health care sector is projected to add over 4.2 million jobs between 2010 and 2020, with 63% of those in
ambulatory settings (offices of health practitioners, home health, and other non-institutional settings” (2012,
CHWS). Health care is booming in all areas of study and research from Holistic to Western Medicine which
include purchasing and supply. Unfortunately this is based off the demand for more Physicians that are not
available where there is a need. The health care industry believe it or not includes the food industry and
health and fitness as well.
The matter of ethics within the health care industry always needs to be address along with the quality of
care for patients. Within this working essay paper I will discuss the matter of; Care & Service Provider,
Ethics (codes and values), Mal-Distribution Physician Labor Forces. Even though the health care industry is
growing the mal-distribution of health care is still evident in some rural areas. This factor of not having
proper care delivered to impoverish neighborhoods and communities is another issue that still plagues the
United States. David Cutler the online journal reporter for PBS News Hour stated, “About 10, 15 percent.
Just to give you one example, Duke University Hospital has 900 hospital beds and 1,300 billing clerks. The
typical Canadian hospital has a handful of billing clerks. Single-payer systems have fewer administrative
needs. That’s not to say they’re better, but that’s just on one dimension that they clearly cost less. What a lot
of those people are doing in America is they are figuring out how to bill different insurers for different
systems, figuring out how to collect money from people, all of that sort of stuff” (2013). The need for health
care workers is great, but the balance is off regarding where the needs are not being meet.

4. DISTRIBUTION OF HEALTH CARE 4
Health Care Distribution
Care and Service Providers
Every year within the United States an open market place is provided for health care providers and
their patients during open enrollment. Within the state of California this is usually done through Cal-
Pers and other company insurance agencies that are elected within that organization. These elected
boards and members are to be the spokes company or group to do the bidding for the patients/workers
during this time of open enrollment. Often within the Health Care Distribution of services the clients
have a gala of insurance plans that they can choose from. From retirement benefits to family package
plans that include vision and dental plans.
Many of the patient workers choose plans and PCP “Health Insurance Providers” that have more
options and more doctors that provide a versatile quality of care vs those that are PP (Private Physician
or PC (Private Care) Doctors that are limited within their abilities. These Doctors often do not provide a
list of ‘Non Primary Care Physicians” as assessable to their patients which cause the Physician to see
less patients than the norm. “The United States does not actively regulate the number, type or
geographic distribution of its physician workforce. Health care professionals can choose how and where
to work. As a result, workforce distribution and patients' access to care rely on market forces, often with
important but inadequate intervention from the government, medical schools and safety-net programs”
(2013, GD). What is the norm within the health care industry is for many Physicians to work within the
primary care sector and the non-primary care sector as well. Example: You may have Dr. Gee working
as a Primary Care Physician and also work as a Naturopathic Physician or Reflexologist. This is also a
form of distribution of care and the United States keeps track and count of where the doctor’s work and
where the care is needed most. “The Association of American Medical Colleges (AAMC) estimates a
124,000–159,000 physician deficit across all specialties by 2025. By 2020, the primary care scarcity will

5. DISTRIBUTION OF HEALTH CARE 5
reach 45,000 physicians.3 Several demographic factors will exacerbate the looming physician shortage.
First, the nation’s population will continue to grow. Between 2006 and 2025, the U.S. Census Bureau
projects population growth of some 50 million” (2011, Petter & Shelly). By observation and stats the
United States will need Doctors, PA, and Practitioners from all class and genres of study from primary
care to holistic. Another form of Health Care Distribution is the pharmaceutical distribution of
prescription drugs. “The report in the January issue of Health Affairs studied the effects of a 2003 law
designed to train more residents in primary care and in rural areas. The Graham Center analysis found
that the legislation, known as the Medicare Prescription Drug Improvement and Modernization Act of
2003, largely failed to achieve those two goals primarily because monitoring and enforcement tools did
not exist to implement the true intent of the law” (2013, FR). The distribution of health care also
includes the prescription drug or pharmacy division which is often readily available within the insurance
package the client/patient/worker applies for during open enrollment time. It is even more available for
people to obtain very low prescription coverage without applying for Medicare/Medicaid or even Cal
Pers. The distribution of drug prescription is at a lower rate of cost more now than ever due to the
manufactures demand and the demand for diverse brands of drugs by the consumer i.e. generic vs name
brand.
Mal-distribution of Physician Labor Forces
In many rural areas across the United States you find a lack of quality of care due to higher demands
in cities verses the rural area. Even though the demand is needed in the rural areas which included the
populations of migrant farm workers and impoverished communities who cannot obtain access to health
facilities; you often find the needed care is there just like in the cities. “The first strategy is to target
future physicians to maximize the pool of physicians available for practice in relatively underserved
regions. This means increasing the number of qualified physicians who are interested in practice in

6. DISTRIBUTION OF HEALTH CARE 6
underserved regions, and/or the number of working hours they are willing to provide. The crucial focal
point of action for this strategy is the selection and education of medical students” (2014, Tomoko,
Schoenstein & Buchan). Often the counties and states where the doctors obtain their degrees will offer
the Doctors or Doctor Student incentives to practice in rural areas which include the loan forgiveness act
that gives students and Doctors a stipend incentive or a free paid college tuition just to work in rural
areas. Often what Doctors are doing is going back into their own communities to work if they come
from rural or impoverished areas.
Ethics (codes and values)
Distribution of Health Care does not just affect the facilities or the supply chains but it also affects
the people that are attempting to obtain the quality of care from these facilities. Distribution of Health
Care means delivering a quality of care to the people who may not have proper access to care in their
areas. Does this mean cut so many cost that the patients get inadequate care? No! By all means more
invasive and modern plans of treatment should be available even though you may not have as many
doctors per patients. Daniels the author of Justice, Health, and Health Care stated, “The central moral
importance, for purpose of justice, of preventing and treating disease and disability with effective health
care services (construed broadly to include public health an environmental measures, as well as personal
medical services) derives from the way in which protecting normal functioning, health care preserves for
people the ability to participate in the political, social, and economic life of their society. It sustains
them as fully participating citizens—normal collaborators and competitors – in all spheres of social life”
(2016, Daniels). Daniels further stated within his writing about the “social good and good of
opportunity” (2016). In which the social good of distribution of health care is really for the social good
of the community as a whole and for the welfare of the people.

7. DISTRIBUTION OF HEALTH CARE 7
When you think of ‘good of opportunity’ this is directed toward the benefit of the health care facility,
manufactures of supplies, and the governing body or shall I say the stakeholders. The ethical values of
the Physicians including the distribution of care are usually values within the Oath taken by Physicians
and the Hippo Laws that govern the quality of care and the distribution of that care. Ethics play a vital
role in every aspect of the delivery of care rather it be by a Doctor or the manufacture of the products
that are used i.e. Pharmacist & Biotech Laboratory. “When most people think of quality in health care,
they think of technical quality (e.g., clinical indicators) and service quality (e.g., patient satisfaction
scores). But ethics quality is equally important.[20] Ethics quality means that practices throughout an
organization are consistent with widely accepted ethical standards, norms, or expectations for a health
care organization and its staff—set out in organizational mission and values statements, codes of ethics,
professional guidelines, consensus statements and position papers, and public and institutional policies”
(2016, Veterans Affairs). The consistency within the health care has to come from all aspects and
departments to ensure that the quality is there this is not just a United States factor but globally as well.
The United States does a lot of out sourcing for goods and services within the health care industry and
the ethical values must be there even if the hospitals and doctors decide to outsource for goods and
services abroad.
Conclusion
The health care industry has room to develop, but at the same time the maldistribution issues must be
examed and corrected by the commissioning boards within all areas and aspects of health care. Rather it
be in the supply department of distribution of goods, customer care, quality of care, sterilization,
primary care, non-primary care, infectious disease control, or ethics including ethical values.
Maldistribution of health care is evident in communities that may be financial impoverished or located
in rural areas within the United States and because of this health care and the quality of care would be

8. DISTRIBUTION OF HEALTH CARE 8
considered maldistributed in society. This form of health care distribution is considered unfair
according to N. Daniels the author of ‘Justice, Health, and Health Care’ whom believes that in order for
people to be viable in society and to have dignity they need to have quality of health care within their
communities. I would have to say, I to believe in what Mr. Daniels elaborated on within his article.
this year’s at the 2016 San Francisco Annual CUGH Global Health Conference committee, Physicians,
Practitioners, Members and Students will discuss the matter of maldistribution of health care, health
services, and quality of care locally and globally. On the itinerary and the agenda located on the website
of the Consortium conferences which will cover matters pertaining to: Global Health Ethics, Advocacy,
Healthy Child Issues, Health, Justice, & the Law, Governance and Management. All these matters will
discuss issues within some form of health care distribution and delivery in the United States and abroad.
To ensure that the issue of maldistribution is covered and addressed properly due to the rising need for
qualified health professionals that are dedicated to their practice and delivery of services it is imperative
that continued discussions, talks, debates, and development be done by Consortiums and similar
conferences.

9. DISTRIBUTION OF HEALTH CARE 9
Reference
David C. (2013.). Why does health care cost so much in America? Ask Harvard’s David Cutler.
Retrieved March 24, 2016, from http://www.pbs.org/newshour/rundown/why-does-health-care-
cost-so-much-in-america-ask-harvards-david-cutler/
E. F., B. C., M. B., & P. B. Retrieved March 24, 2016, from http://www.ethics.va.gov/ELprimer.pdf
F., & C. (2013.). Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care
Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2014
Rates; Quality Reporting Requirements for Specific Providers; Hospital Conditions of
Participation; Payment Policies Related to Patient Status. The Daily Journal of the United States
Government. Retrieved August 19, 2013, from
https://www.federalregister.gov/articles/2013/08/19/2013-18956/medicare-program-hospital-
inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the.
Geographic Distribution of Primary Care Physicians Affects Health Care, Says Policy Brief. (2013).
Retrieved March 23, 2016, from http://www.aafp.org/news/government-
medicine/20130620geodistpolicy.html
J. A. (2013, February 5). Reforming GME to Train More Primary Care Physicians Will Require
Enforcement. Retrieved March 23, 2016, from http://www.aafp.org/news/education-
professional-development/20130205gmereformsreport.html
Jacobson, P. D., & Jazowski, S. A. (2011). Physicians, the Affordable Care Act, and primary care:
Disruptive change or business as usual? Journal of General Internal Medicine, 26(8), 934-937.
N. Daniels. (2016). Justice, Health, and Health Care. Retrieved March 23, 2016, from
http://www.hsph.harvard.edu/benchmark/ndaniels/pdf/justice_health.pdf
Tomoko, O., Schoenstein, M., & Buchan, J. (2014, April 3). Mal distribution of the physician supply.
Retrieved March 23, 2016, from http://www.pnhp.org/news/2014/april/maldistribution-of-the-
physician-supply