Urbanization and physician maldistribution: a longitudinal study in Japan
Urbanization and physician maldistribution: a longitudinal study in Japan
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DOI：
10.1186/1472-6963-11-260
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发表时间：
2011-10-08
影响因子：
2.8
通讯作者：
Kawachi, Ichiro
中科院分区：
文献类型：
--
作者：
Tanihara, Shinichi;Kobayashi, Yasuki;Kawachi, Ichiro
背景：日本农村地区医生的相对短缺是卫生政策中的一个重要问题。在20世纪70年代，日本政府开始了一项政策，以增加医科学生的数量，并实现更好的医生分布。然而，从1985年开始，医学院的入学人数减少了，以防止将来医生供过于求。2007年，医学院新生仅相当于1982年同侪的92%。城市人口年增长率为正，农村人口年增长率为负，这一趋势可能影响分母人口和医生分布。方法：采用1998年、2000年、2002年、2004年、2006年和2008年6个时间点，跨越10年。用于分析的空间单位是《医疗服务法》和相关立法所界定的医疗服务（STM）的二级。我们研究了日本348家stm的人口和医生分布的地理差异趋势。我们比较了每个STM的人口和每10万人中医生的数量。为了定量测量不均匀分布，我们计算了医生分布的基尼系数。结果：1998 - 2008年，全国总人口和每10万人执业医师人数分别增长0.95%和13.6%。然而，医生分布的不平等仍然保持不变，尽管小地区和大部分农村地区的医生与人口比例有所增加。与此相反，随着同期人口分布不均衡加剧，人口基尼系数上升。虽然小型中医院执业医师的绝对数量有所减少，但由于中医院分母人口的减少，导致农村地区中医院人均执业医师数量有所增加。结论：在1998年至2008年期间，在日本所有地理区域，无论大小，增加医生数量和医生与人口比率的政策并没有导致医生的地理分布更加平等。在小型农村stm中，医生与人口的比例增加是因为城市化的同步趋势，而不是因为执业医生数量的增加。
Background: The relative shortage of physicians in Japan's rural areas is an important issue in health policy. In the 1970s, the Japanese government began a policy to increase the number of medical students and to achieve a better distribution of physicians. Beginning in 1985, however, admissions to medical school were reduced to prevent a future oversupply of physicians. In 2007, medical school entrants equaled just 92% of their 1982 peers. The urban annual population growth rate is positive and the rural is negative, a trend that may affect denominator populations and physician distribution.Methods: Our data cover six time points and span a decade: 1998, 2000, 2002, 2004, 2006, and 2008. The spatial units for analysis are the secondary tier of medical care (STM) as defined by the Medical Service Law and related legislation. We examined trends in the geographic disparities in population and physician distribution among 348 STMs in Japan. We compared populations and the number of physicians per 100,000 populations in each STM. To measure maldistribution quantitatively, we calculated Gini coefficients for physician distribution.Results: Between 1998 and 2008, the total population and the number of practicing physicians for every 100,000 people increased by 0.95% and 13.6%, respectively. However, the inequality of physician distribution remained constant, although small and mostly rural areas experienced an increase in physician to population ratios. In contrast, as the maldistribution of population escalated during the same period, the Gini coefficient of population rose. Although the absolute number of practicing physicians in small STMs decreased, the fall in the denominator population of the STMs resulted in an increase in the number of practicing physicians per population in those located in rural areas.Conclusions: A policy that increased the number of physicians and the physician to population ratios between 1998 and 2008 in all geographic areas of Japan, irrespective of size, did not lead to a more equal geographical distribution of physicians. The ratios of physicians to population in small rural STMs increased because of concurrent trends in urbanization and not because of a rise in the number of practicing physicians.