Division of Community and Family Medicine, Centre for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
Health Policy. 2010 Aug;96(3):239-44. doi: 10.1016/j.healthpol.2010.02.008. Epub 2010 Mar 11.
Geographic and specialty maldistributions of physicians are political concerns in Japan. This study examined the associations of physician employment status with the number and geographic distribution of the physicians in each specialty in Japan, in comparison with the US.
The number of physicians per unit population, proportion of clinic (Japan) or office (US) based physicians, and Gini coefficient of physicians against population were calculated in each of 20 specialties in Japan, and 21 specialties in the US. The geographic unit of Gini coefficient was municipality in Japan, and county in the US. Correlations among these three variables were also examined.
The lower the proportion of clinic-based physicians was, the lower the number of physicians and the higher the Gini coefficient were in Japanese specialties, while there was no association between office-based rate and Gini coefficient in the US specialties. In radiology, anaesthesiology, emergency medicine, and pathology, Japanese clinic-based rates were less than one-tenth, and the numbers of physicians per unit population were less than half of the US values, and the Gini coefficients were substantially higher than the US values.
Difficulty in being self-employed created low numbers in some specialties, and highly urban-biased distributions of these specialists in Japan.
医师的地域和专业分布不均是日本的政治关注点。本研究比较了日本和美国各专业医师的就业状况与数量和地域分布的关系。
计算了日本 20 个专业和美国 21 个专业中每单位人口的医师人数、诊所（日本）或办公室（美国）医师的比例以及医师对人口的基尼系数。日本的基尼系数地理单位是市，美国的是县。还检查了这三个变量之间的相关性。
日本专科中，诊所为基础的医师比例越低，医师数量越低，基尼系数越高，而美国专科中，基于办公室的比率与基尼系数之间没有关联。在放射科、麻醉科、急诊医学和病理学中，日本的诊所基础率不到十分之一，每单位人口的医师人数不到美国的一半，基尼系数大大高于美国。
在某些专业中，自我就业的困难导致数量较少，而这些专家在日本高度偏向城市分布。
