Examining changes in the equity of physician distribution in Japan: a specialty-specific longitudinal study

Abstract

ObjectivesIn 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.MethodsThe 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.ResultsOver 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.ConclusionBetween 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.

Future projection of the physician workforce and its geographical equity in Japan: a cohort-component model

“… 2 38 In addition, this may also be related to changes in physicians’ specialist orientations in Japan. 23 39 40 This may lead to a concentration of physicians in urban areas because physicians with high expertise (or physicians trying to become such physicians) are likely to be concentrated in urban areas due to the facilities, environment and number of cases.…”

Modeling a Production Function to Evaluate the Effect of Medical Staffing on Antimicrobial Stewardship Performance in China, 2009–2016: Static and Dynamic Panel Data Analyses

“…In addition to the three core groups, we also consider nurses because they account for the largest clinical discipline, and always serve as executors of antimicrobial stewardship (Olans et al, 2016 ; Monsees et al, 2017 ). Dividing the numbers by 100,000 populations adjusts the population for their health care demand (Tanihara et al, 2011 ; Hara et al, 2018 ).…”

Equality in the Distribution of Maternal and Child Care Providers in the Public Sector of Lorestan Province, Iran

“…A study conducted in Japan between 2000 and 2014 also presented an increase in inequality in the distribution of gynecologists based on the Gini coefficient, with the Gini coefficient in the year 2000 rising from 0.23 to 0.28 in 2014 (37). This is despite the fact that international and national orientations in recent decades have been in the direction of equal distribution of health services; therefore, the study of the reasons for failure in the fair distribution of health services is an inevitable necessity.…”