We address geographic inequities in primary care physician (PCP) access in Germany.

Our greedy algorithm identifies a 6 % PCP shortage, especially in rural areas.

Municipality traits like purchasing power & schools explain urban-rural differences.

Our needs-based approach offers a framework to optimize PCP allocation nationwide.

Equal access to primary care is essential for a reliable health-care system, as it influences health outcomes, reduces follow-up visits, and lowers overall healthcare costs. However, inequalities in access, often driven by the uneven geographical distribution of primary care physicians, remain an issue in Germany.

We investigate the regional distribution of primary care physicians in Germany and analyze to what extent regional disparities can be explained by observable infrastructural and environmental characteristics.

To investigate our research question, we apply a greedy capacitated algorithm on very fine spatial data. We compare our reference allocation of primary care physicians to the status quo using OLS regressions and a Oaxaca-Blinder decomposition.

Our findings indicate a shortage of primary care physicians in Germany of approximately 6%, with rural areas being particularly affected. While some disparities can be partially explained by factors such as purchasing power and the number of schools, significant portions of the variation remain unexplained.

We offer ideas on how to improve primary care location planning and reduce regional disparities based on an algorithmic reference allocation and the analyzes of infrastructural and environmental factors’ impact on regional disparities. While being limited by the exclusion of other determinants of health, we provide a foundation for developing more targeted policies.

Health and Inequality

Optimization techniques

Regional economics

© 2025 The Authors. Published by Elsevier B.V.