Ding Hansheng, Koinuma Nobuo, Ito Michiya, Nakamura Toshihito
Department of Health Administration and Policy, Tohoku University, Graduate School of Medicine, Sendai, Japan.
Tohoku J Exp Med. 2005 Jul;206(3):195-202. doi: 10.1620/tjem.206.195.
The shortage of pediatricians and emergency medical care for children is an issue of great concern in Japan. This study attempts to identify the problems in children's medical care and their causes. With multiple secondary data sources, we found that over 80% of outpatient pediatric services were provided by clinics, that over 95% of clinics were closed on holidays, Sunday, and Saturday night, that among the children's illnesses respiratory ailments were dominant and were generally acute and required immediate treatment or consultation, and that the revenue rates from providing services for children were lower than those for adults. That fewer clinics are open on Saturday night, Sunday and holidays, and workday evenings may be the main reason why it is difficult for children to find pediatric services outside of normal working hours. Lower revenue rates may be one of the key reasons why the number and rate of clinics and hospitals providing pediatric services continue to decline, and fewer physicians are willing to provide services for children. The findings in this research would provide important information of multiple dimensions for the governments to make efforts to improve pediatric services in Japan. Our proposition is to prompt pediatric specialists and internists who can treat pediatric cases in clinics to provide pediatric service systematically and alternatively at night, and to adjust the fee-for-service scales of pediatric services.
儿科医生短缺以及儿童紧急医疗护理不足是日本备受关注的问题。本研究旨在找出儿童医疗护理中的问题及其成因。通过多个二手数据源，我们发现超过80%的儿科门诊服务由诊所提供，超过95%的诊所在节假日、周日和周六晚上关门，儿童疾病中呼吸道疾病占主导，且通常为急性，需要立即治疗或咨询，为儿童提供服务的收入率低于为成人提供服务的收入率。周六晚上、周日和节假日以及工作日晚上营业的诊所较少，这可能是儿童在正常工作时间之外难以找到儿科服务的主要原因。收入率较低可能是提供儿科服务的诊所和医院数量及比例持续下降、愿意为儿童提供服务的医生减少的关键原因之一。本研究结果将为日本政府努力改善儿科服务提供多方面的重要信息。我们的建议是促使能够在诊所治疗儿科病例的儿科专科医生和内科医生在夜间系统地交替提供儿科服务，并调整儿科服务的按服务收费标准。
