Incorporating Medical Supply and Demand into the Index of Physician Maldistribution Improves the Sensitivity to Healthcare Outcomes

Abstract

Background: Since the association between disparity in physician distribution and specific healthcare outcomes is poorly documented, we aimed to clarify the association between physician maldistribution and cerebrovascular disease (CeVD), a high-priority health outcome in Japan. Methods: In this cross-sectional study, we conducted multivariable regression analysis with the Physician Uneven Distribution Index (PUDI), a recently developed and adopted policy index in Japan that uniquely incorporates the gap between medical supply and demand, as the independent variable and CeVD death rate as the dependent variable. Population density, mean annual income, and prevalence of hypertension were used as covariates. Results: The coefficient of the PUDI for the CeVD death rate was −0.34 (95%CI: −0.49–−0.19) before adjusting for covariates and was −0.19 (95%CI: −0.30–−0.07) after adjusting. The adjusted R squared of the analysis for the PUDI was 0.71 in the final model. However, the same multivariable regression model showed that the number of physicians per 100,000 people (NPPP) was not associated with the CeVD death rates before or after adjusting for the covariates. Conclusion: Incorporating the gap between the medical supply and demand in physician maldistribution indices could improve the responsiveness of the index for assessing the disparity in healthcare outcomes.

Association between physicians’ maldistribution and core clinical competency in resident physicians

“…Japan is currently experiencing a severe crisis in local healthcare delivery due to the uneven distribution of physicians, which is exacerbating the critical situation in community hospitals in rural areas. 1,2 The insufficient number of physicians in rural areas due to urbanization remains a serious problem. 3–5 The issue of physician maldistribution is not unique to Japan; it is a global concern affecting China, India, England, Canada, the United States, Australia, and European nations.…”

“…In 2019, the Ministry of Health, Labour and Welfare (MHLW) initiated an intervention policy aimed at rectifying geographical disparities in physician distribution at the prefectural level. 1,12–14 This policy introduced the physician uneven distribution (PUD) index. The PUD index was designed to gauge the extent of physician maldistribution by considering both medical supply and demand at the prefectural level (Supplement 1).…”

Tacámbaro, Ario de Rosales y Grazalema: a humanistic geography perspective of elsewhereness, placelessness and personality

“…The uneven distribution of the healthcare workforce delineated differences in efficiency (high healthcare workforce density is associated with increased utilisation of medical services) and equity (high healthcare workforce density is associated with better medical outcomes, higher average income, and lower need for healthcare). In addition, multidimensional indices to assess the imbalances and reduce physician distribution were developed, such as PUD (Physicians Uneven Distribution) and HRSA (Health Professional Shortage Area) (Department of Health, 1998;Takayama & Poudyal, 2021). However, a study using OECD data from 19 countries to assess the relationship between physician supply and healthcare outcomes suggests that more physicians will not necessarily translate into better healthcare outcomes (Watson & McGrail, 2009).…”