Inequalities in GPs serving rural and urban areas in Romania (2020-2024)

Background

Romania faces persistent health workforce shortages, with marked disparities in GP availability between rural and urban areas. This study examines inequalities in GP distribution within each county (2020-2024).

Methods

GP counts for 41 counties and the municipality of Bucharest were retrieved from National Institute of Statistics (NIS) reports, disaggregated by area (rural/urban) and property type (public/private). GP rates per 10,000 and weighted Gini coefficients were calculated using the “reldist” package in R v4.3.3.

Results

Urban public-sector GP rates ranged from 0.09 (Ialomița) to 3.70 (Iași) in 2020 and from 0 (Ilfov) to 9.0 (Timiș) in 2024. Urban private-sector rates ranged from 3.27 (Ilfov) to 8.59 (Bucharest) in 2020 and 3.25 (Ilfov) to 10.55 (Timiș) in 2024. Rural public-sector GP rates were near zero in all counties: 0 (Bihor) to 0.11 (Ilfov) in 2020 and 0 (Bihor) to 0.19 (Brăila) in 2024. Rural private-sector rates ranged from 3.46 (Vaslui) to 7.81 (Dolj) in 2020 and 3.09 (Călărași) to 7.48 (Arad) in 2024. Gini coefficients indicated high inequality among public-sector GPs in rural (0.92 in 2020; 0.86 in 2024) and urban areas (0.45 in 2020; 0.55 in 2024), with urban public-sector inequality increasing over time.

Conclusions

Significant and persistent inequalities in GP distribution exist across Romanian counties, especially in the public sector. Rural areas remain critically underserved, while private-sector coverage is more evenly spread. Targeted workforce policies are urgently needed to improve equitable access to primary care.

Key messages

• Public-sector GP distribution is highly unequal in rural and urban Romania; urban public-sector inequality worsened from 2020 to 2024.

• Private-sector GPs partially offset gaps but cannot substitute for public investment; workforce policies targeting rural primary care are essential.