Yamauchi Kazushi, Funada Takao, Shimizu Hiroshi, Kawahara Kazuo
Tokyo Medical and Dental University, Department of Health Policy Science, Tokyo, Japan.
J Med Dent Sci. 2007 Mar;54(1):57-63.
The regional discrepancies of physician supply have been a growing concern in Japan. To find out how hospitals are responding in terms of physician payment (by monthly salaries and additional benefits), we conducted a survey of acute care hospitals in Yamagata, Japan. We asked about the salary and additional benefits of full-time physicians and the structural and functional characteristics of health care service provision. From these data we set out to assemble a model that can explain effectively the variability of physician payment in acute care hospitals within the prefecture. We found that physician payment was associated with variables such as type of management, staff employed per bed, full time doctors employed per bed and average length of stay. Hospital location was found to have a significant effect on payment. Variables expressing workload, like number of in-patients per doctor and number of surgical operations per doctor were inversely related. Our results suggest that hospitals may have adapted to physician preferences of workplace in terms of physician payment. To further address the problems of unbalanced geographic distribution of physicians in rural areas, work-sharing and educational and technical support schemes may also help.
医生供给的地区差异在日本一直是一个日益受到关注的问题。为了了解医院在医生薪酬（月薪和额外福利）方面的应对情况，我们对日本山形县的急症医院进行了一项调查。我们询问了全职医生的薪资和额外福利以及医疗服务提供的结构和功能特征。基于这些数据，我们着手构建一个模型，该模型能够有效解释该地区急症医院医生薪酬的差异。我们发现医生薪酬与管理类型、每张病床的员工数量、每张病床的全职医生数量以及平均住院天数等变量相关。研究发现医院位置对薪酬有显著影响。表示工作量的变量，如每位医生的住院患者数量和每位医生的外科手术数量呈负相关。我们的结果表明，医院可能在医生薪酬方面适应了医生对工作场所的偏好。为了进一步解决农村地区医生地理分布不均衡的问题，工作分担以及教育和技术支持计划可能也会有所帮助。
