Hara Koji, Kunisawa Susumu, Sasaki Noriko, Imanaka Yuichi
Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
BMJ Open. 2018 Jan 8;8(1):e018538. doi: 10.1136/bmjopen-2017-018538.
In this longitudinal study, we examined changes in the geographical distribution of physicians in Japan from 2000 to 2014 by clinical specialty with adjustments for healthcare demand based on population structure.
The Japanese population was adjusted for healthcare demand using health expenditure per capita stratified by age and sex. The numbers of physicians per 100 000 demand-adjusted population (DAP) in 2000 and 2014 were calculated for subprefectural regions known as secondary medical areas. Disparities in the geographical distribution of physicians for each specialty were assessed using Gini coefficients. A subgroup analysis was conducted by dividing the regions into four groups according to urban-rural classification and initial physician supply.
Over the study period, the number of physicians per 100 000 DAP decreased in all specialties assessed (internal medicine: -6.9%, surgery: -26.0%, orthopaedics: -2.1%, obstetrics/gynaecology (per female population): -17.5%) except paediatrics (+33.3%) and anaesthesiology (+21.1%). No reductions in geographical disparity were observed in any of the specialties assessed. Geographical disparity increased substantially in internal medicine, surgery and obstetrics and gynaecology(OB/GYN). Rural areas with lower initial physician supply experienced the highest decreases in physicians per 100 000 DAP for all specialties assessed except paediatrics and anaesthesiology. In contrast, urban areas with lower initial physician supply experienced the lowest decreases in physicians per 100 000 DAP in internal medicine, surgery, orthopaedics and OB/GYN, but the highest increase in anaesthesiology.
Between 2000 and 2014, the number of physicians per 100 000 DAP in Japan decreased in all specialties assessed except paediatrics and anaesthesiology. There is also a growing urban-rural disparity in physician supply in all specialties assessed except paediatrics. Additional measures may be needed to resolve these issues and improve physician distribution in Japan.
在这项纵向研究中，我们根据人口结构对医疗保健需求进行了调整，研究了2000年至2014年日本按临床专科划分的医生地理分布变化。
使用按年龄和性别分层的人均医疗支出对日本人口的医疗保健需求进行调整。计算了2000年和2014年称为二级医疗区域的次县级地区每10万需求调整人口（DAP）中的医生数量。使用基尼系数评估各专科医生地理分布的差异。根据城乡分类和初始医生供应情况将地区分为四组进行亚组分析。
在研究期间，除儿科（+33.3%）和麻醉科（+21.1%）外，所有评估专科的每10万DAP医生数量均有所下降（内科：-6.9%，外科：-26.0%，骨科：-2.1%，妇产科（按女性人口计算）：-17.5%）。在任何评估的专科中均未观察到地理差异的减少。内科、外科和妇产科的地理差异大幅增加。除儿科和麻醉科外所有评估专科中，初始医生供应较低的农村地区每10万DAP医生数量下降幅度最大。相比之下，初始医生供应较低的城市地区在内科、外科、骨科和妇产科中每10万DAP医生数量下降幅度最小，但麻醉科增加幅度最大。
2000年至2014年期间，日本除儿科和麻醉科外所有评估专科的每10万DAP医生数量均有所下降。除儿科外，所有评估专科的医生供应城乡差距也在扩大。可能需要采取额外措施来解决这些问题并改善日本的医生分布情况。
