Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Soc Sci Med. 2010 Dec;71(11):2014-9. doi: 10.1016/j.socscimed.2010.09.005. Epub 2010 Sep 29.
The geographical distribution of health professionals reflects behavioral characteristics of such professionals and of the health system in which they work. The spill-over hypothesis asserts that their oversupply leads to a more even geographic distribution. The current surplus of dentists in Japan is a suitable opportunity to observe such situations. This study demonstrates the transition of the geographic distribution of dentists from 1980 to 2000 in comparison with that of physicians. Using data from the Population Census and the Physician, Dentist, and Pharmacist Census, we calculated the ratio of dentists working in clinics and hospitals per population in 1980, 1990, and 2000 and the Gini coefficients according to the municipality boundaries at the end of 2000. We also plotted the municipalities on a graph, which illustrated the ratios of the dentists by population. We did the same analysis with physician data. The number of dentists increased by 71% during the 20 years studied. The ratios of dentists/100,000 population were 44.1, 58.3, and 69.7 in 1980, 1990, and 2000, respectively. The Gini coefficients for dentists by municipality were 0.270, 0.213, and 0.197, excluding the municipalities with a dental university or its hospital. In contrast, the Gini coefficients for physicians barely changed while the number of physicians increased by 60% during the same periods. The graphs for dentists appeared to indicate the ceiling of those ratios (approximately 100 dentists/100,000 population), but such a ceiling was not seen for physicians. The supply of dentists might have reached a level that generated the geographic diffusion and redistribution of dentists in Japan, in contrast with the situation involving physicians. This supports some results from other countries suggesting that saturation of local markets for health professionals may result in geographical redistribution, producing a more equal pattern of provision across the national space.
卫生专业人员的地域分布反映了他们自身的行为特征和他们所工作的卫生系统的特征。溢出假说认为，卫生专业人员的供应过剩会导致更均衡的地域分布。日本目前牙医过剩的情况为观察这种情况提供了一个合适的机会。本研究通过比较牙医和医生的地域分布，展示了从 1980 年到 2000 年牙医地域分布的变化。本研究利用人口普查和医生、牙医和药剂师普查的数据，计算了 1980 年、1990 年和 2000 年每 10 万人口在诊所和医院工作的牙医比例，以及截至 2000 年底按市界计算的基尼系数。我们还将市标绘在图表上，显示了按人口计算的牙医比例。我们用医生的数据进行了同样的分析。在研究期间的 20 年中，牙医人数增加了 71%。每 10 万人口的牙医比例分别为 1980 年的 44.1、1990 年的 58.3 和 2000 年的 69.7。市际牙医基尼系数分别为 0.270、0.213 和 0.197，不包括有牙科学院或其附属医院的市。相比之下，医生的基尼系数几乎没有变化，而同期医生人数增加了 60%。牙医的图表似乎表明了这些比例的上限（大约每 10 万人口 100 名牙医），但医生的图表没有显示出这样的上限。日本牙医的供应可能已经达到了一个水平，导致了牙医在日本的地域扩散和再分配，这与医生的情况形成了对比。这支持了来自其他国家的一些结果，即卫生专业人员当地市场的饱和可能导致地域重新分配，在全国范围内形成更平等的供应模式。
