Examining changes in the equity of physician distribution in Japan: a specialty-specific longitudinal study.
Examining changes in the equity of physician distribution in Japan: a specialty-specific longitudinal study.
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检查日本医师分布平等的变化：一项专业特定的纵向研究。
DOI：
10.1136/bmjopen-2017-018538
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发表时间：
2018-01-08
期刊：
影响因子：
2.9
通讯作者：
Imanaka Y
中科院分区：
文献类型：
--
作者：
Hara K;Kunisawa S;Sasaki N;Imanaka Y
在本纵向研究中，我们根据人口结构调整了医疗需求，并按临床专业调查了2000年至2014年日本医生的地理分布变化。使用按年龄和性别分层的人均卫生支出对日本人群的医疗保健需求进行了调整。2000年和2014年每10万需求调整人口（DAP）的医生人数是针对被称为二级医疗区的次县地区计算的。使用基尼系数评估每个专业的医生地理分布的差异。通过根据城乡分类和初始医生供应将地区分为四组进行亚组分析。在研究期间，除儿科（+33.3%）和麻醉科（+21.1%）外，所有评估的专科（内科：-6.9%，外科：-26.0%，骨科：-2.1%，产科/妇科（按女性人口）：-17.5%）中每100，000 DAP的医生人数都有所下降。在所评估的任何专科中均未观察到地域差异减少。在内科、外科和妇产科，地域差距大幅度扩大。初始医生供应量较低的农村地区，除儿科和麻醉科外，每100 000 DAP评估的所有专科的医生减少幅度最大。相比之下，初始医生供应量较低的城市地区在内科、外科、骨科和OB/GYN方面每100 000 DAP的医生减少最少，但在麻醉学方面增加最多。在2000年至2014年期间，日本每10万DAP的医生数量在除儿科和麻醉科外的所有评估专业中均有所下降。除儿科外，在所有评估的专业中，城乡医生供应的差距也越来越大。可能需要采取其他措施来解决这些问题，并改善日本的医生分布。
In this longitudinal study, we examined changes in the geographical distribution of physicians in Japan from 2000 to 2014 by clinical specialty with adjustments for healthcare demand based on population structure. The Japanese population was adjusted for healthcare demand using health expenditure per capita stratified by age and sex. The numbers of physicians per 100 000 demand-adjusted population (DAP) in 2000 and 2014 were calculated for subprefectural regions known as secondary medical areas. Disparities in the geographical distribution of physicians for each specialty were assessed using Gini coefficients. A subgroup analysis was conducted by dividing the regions into four groups according to urban–rural classification and initial physician supply. Over the study period, the number of physicians per 100 000 DAP decreased in all specialties assessed (internal medicine: −6.9%, surgery: −26.0%, orthopaedics: −2.1%, obstetrics/gynaecology (per female population): −17.5%) except paediatrics (+33.3%) and anaesthesiology (+21.1%). No reductions in geographical disparity were observed in any of the specialties assessed. Geographical disparity increased substantially in internal medicine, surgery and obstetrics and gynaecology(OB/GYN). Rural areas with lower initial physician supply experienced the highest decreases in physicians per 100 000 DAP for all specialties assessed except paediatrics and anaesthesiology. In contrast, urban areas with lower initial physician supply experienced the lowest decreases in physicians per 100 000 DAP in internal medicine, surgery, orthopaedics and OB/GYN, but the highest increase in anaesthesiology. Between 2000 and 2014, the number of physicians per 100 000 DAP in Japan decreased in all specialties assessed except paediatrics and anaesthesiology. There is also a growing urban–rural disparity in physician supply in all specialties assessed except paediatrics. Additional measures may be needed to resolve these issues and improve physician distribution in Japan.
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影响因子：
4.5
作者：
Sasaki H;Otsubo T;Imanaka Y
通讯作者：
Imanaka Y
影响因子：
2.9
作者：
Matsumoto M;Takeuchi K;Tanaka J;Tazuma S;Inoue K;Owaki T;Iguchi S;Maeda T
通讯作者：
Maeda T
影响因子：
168.9
作者：
Kanchanachitra, Churnrurtai;Lindelow, Magnus;dela Rosa, Jennifer Frances
通讯作者：
dela Rosa, Jennifer Frances
影响因子：
2.8
作者：
Tanihara, Shinichi;Kobayashi, Yasuki;Kawachi, Ichiro
通讯作者：
Kawachi, Ichiro
影响因子：
6
作者：
Asano, N;Kobayashi, Y;Kano, K
通讯作者：
Kano, K