Division of Community and Family Medicine, Centre for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
Health Policy. 2010 May;95(2-3):129-36. doi: 10.1016/j.healthpol.2009.11.012. Epub 2009 Dec 11.
To assess the effects of geographic diffusion of physicians from medically oversupplied toward undersupplied areas driven by economic competition among physicians and political interventions in Japan and US.
A quantitative evaluation of physician workforce changes at the community level between 1980 and 2005, using municipality-based (Japan) and county-based (US) census data.
The overall number of physicians per 100,000 population (physician-to-population ratio: PPR) increased from 130 to 203 in Japan and 158 to 234 in US. In this context, a higher proportion (30.1%) of the quintile communities with lowest PPRs in 1980 has further decreased their PPRs in US than in Japan (21.6% in 2005). In multivariate analysis low PPR was a positive predictor of PPR decrease in the US communities (odds ratio 1.26; 95% confidence interval 1.01-1.58), while it was a negative predictor in Japanese communities (0.69; 0.57-0.83).
Physician scarcity is associated with further scarcity in US communities, while scarcity is associated with recovery from scarcity in Japanese communities. Competition-based physician diffusion strategies and various interventions to address the maldistribution of physicians apparently have not worked effectively in US compared with Japan.
评估日本和美国的医生之间的经济竞争和政治干预驱动的医师从供过于求地区向供应不足地区的地理扩散对医生人数的影响。
利用基于市（日本）和基于县（美国）的人口普查数据，对 1980 年至 2005 年社区一级医生人数的变化进行定量评估。
每 100,000 人口的医生人数（医生与人口的比例：PPR）从 1980 年的日本 130 人增加到 203 人，美国从 158 人增加到 234 人。在此背景下，1980 年 PPR 最低的五分之一社区中，有更高比例（30.1%）的社区在 2005 年的 PPR 在美国进一步下降，而在日本的下降比例较低（21.6%）。多元分析显示，美国社区的低 PPR 是 PPR 下降的正预测因素（比值比 1.26；95%置信区间 1.01-1.58），而在日本社区则是负预测因素（0.69；0.57-0.83）。
在美国社区，医生短缺与进一步短缺相关，而在日本社区，医生短缺与从短缺中恢复相关。与日本相比，以竞争为基础的医生扩散策略和各种干预措施显然并未有效地解决美国医生分布不均的问题。
