儿科医生的执业地点选择——评估日本 2004 年研究生培训计划对儿科医生空间分布的影响。
Pediatricians' practice location choice-Evaluating the effect of Japan's 2004 postgraduate training program on the spatial distribution of pediatricians.
机构信息
Department of Social and Behavioral Sciences, Harvard School of Public Health.
出版信息
J Epidemiol. 2014;24(3):239-49. doi: 10.2188/jea.je20130117. Epub 2014 Mar 29.
OBJECTIVES
To explore determinants of change in pediatrician supply in Japan, and examine impacts of a 2004 reform of postgraduate medical education on pediatricians' practice location choice.
METHODS
Data were compiled from secondary data sources. The dependent variable was the change in the number of pediatricians at the municipality ("secondary tier of medical care" [STM]) level. To analyze the determinants of pediatrician location choices, we considered the following predictors: initial ratio of pediatricians per 1000 children under five years of age (pediatrician density) and under-5 mortality as measures of local area need, as well as measures of residential quality. Ordinary least-squares regression models were used to estimate the associations. A coefficient equality test was performed to examine differences in predictors before and after 2004. Basic comparisons of pediatrician coverage in the top and bottom 10% of STMs were conducted to assess inequality in pediatrician supply.
RESULTS
Increased supply was inversely associated with baseline pediatrician density both in the pre-period and post-period. Estimated impact of pediatrician density declined over time (P = 0.026), while opposite trends were observed for measures of residential quality. More specifically, urban centers and the SES composite index were positively associated with pediatrician supply for the post-period, but no such associations were found for the pre-period. Inequality in pediatrician distribution increased substantially after the reform, with the best-served 10% of communities benefitting from five times the pediatrician coverage compared to the least-served 10%.
CONCLUSIONS
Residential quality increasingly became a function of location preference rather than public health needs after the reform. New placement schemes should be developed to achieve more equity in access to pediatric care.
目的
探讨日本儿科医生供给变化的决定因素，并考察 2004 年研究生医学教育改革对儿科医生执业地点选择的影响。
方法
数据来自二手资料来源。因变量为市（“二级医疗保健”[STM]）一级儿科医生人数的变化。为分析儿科医生选址的决定因素，我们考虑了以下预测因素：0-5 岁以下儿童每千人口的初始儿科医生比例（儿科医生密度）和 0-5 岁以下儿童死亡率作为当地需求的衡量标准，以及居住质量的衡量标准。使用普通最小二乘回归模型来估计关联。进行系数相等性检验，以检查 2004 年前后预测因素的差异。对前 10%和后 10%的 STM 进行儿科医生覆盖率的基本比较，以评估儿科医生供应的不平等性。
结果
在前后两个时期，供应量的增加与基线儿科医生密度呈反比。儿科医生密度的估计影响随时间而下降（P = 0.026），而居住质量的衡量标准则呈现相反的趋势。更具体地说，城市中心和 SES 综合指数与后一时期的儿科医生供应呈正相关，但在前期没有发现这种关联。改革后，儿科医生分布的不平等性大幅增加，服务最好的 10%社区的儿科医生覆盖率是服务最差的 10%社区的五倍。
结论
改革后，居住质量越来越成为地点偏好而不是公共卫生需求的函数。应制定新的安置计划，以实现儿科保健获取方面的更大公平。
Zotero 插件