Takayama Atsushi, Poudyal Hemant
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Population Health and Policy Research Unit, Kyoto University Graduate School of Medicine, Kyoto, Japan.
JMA J. 2025 Apr 28;8(2):506-516. doi: 10.31662/jmaj.2024-0241. Epub 2025 Feb 28.
Because regional physician maldistribution is considered a potential contributor to disparities in healthcare outcomes, several countries regulate the number of physicians and specialists per region to ameliorate health disparities. However, the association between regional physician maldistribution and specific outcomes, such as out-of-hospital cardiac arrest (OHCA) at the regional level, remains unclear. This study aims to evaluate the association between regional physician and specialist maldistribution and OHCA outcomes.
This ecological study used 12 years of longitudinal public open datasets in Japan. We examined the disparity trends of indices of physician and specialist (emergency physicians, cardiologists, and cardiac surgeons) distribution using the Gini index. We also examined the physician uneven distribution index, a newly introduced policy index incorporating local demand and supply of medical services. Next, we analyzed the association between these distributions and OHCA-related outcomes (30-day survival rate and 30-day favorable neurological outcome).
The overall number of physicians and each specialist steadily increased throughout all regions and the observation period, but the trends in the regional distribution of specialists for each region were not always synchronized with the distribution of overall physicians. Although the disparity within each index has gradually decreased, the disparity of specialists remained high compared with overall physicians. Moreover, regional physician distributions, which showed the lowest level of disparity across regions, were consistently associated with OHCA-related outcomes, whereas the regional disparity of specialists, which consistently exhibited a higher level of disparity, was not associated with the outcomes.
Paradoxically, the unevenly distributed specialist distribution indices did not reflect their relevant outcomes, despite their direct involvement in the specific outcomes. Therefore, our findings call into question the validity of policies aimed at correcting the total number of physicians without considering the impact of specialists on healthcare outcomes.
由于地区医生分布不均被认为是导致医疗保健结果差异的一个潜在因素，一些国家对每个地区的医生和专科医生数量进行监管，以改善健康差异。然而，地区医生分布不均与特定结果之间的关联，如地区层面的院外心脏骤停（OHCA），仍不明确。本研究旨在评估地区医生和专科医生分布不均与OHCA结果之间的关联。
这项生态学研究使用了日本12年的纵向公共开放数据集。我们使用基尼指数研究了医生和专科医生（急诊医生、心脏病专家和心脏外科医生）分布指数的差异趋势。我们还研究了医生不均衡分布指数，这是一个新引入的政策指数，纳入了当地医疗服务的需求和供给。接下来，我们分析了这些分布与OHCA相关结果（30天生存率和30天良好神经功能结局）之间的关联。
在整个观察期内，所有地区的医生和各专科医生总数稳步增加，但每个地区专科医生的地区分布趋势并不总是与全体医生的分布同步。尽管每个指数内的差异逐渐减小，但与全体医生相比，专科医生的差异仍然很大。此外，地区医生分布在各地区间差异最小，与OHCA相关结果始终相关，而专科医生的地区差异始终较高，与结果无关。
矛盾的是，尽管专科医生直接参与特定结果，但分布不均的专科医生分布指数并未反映其相关结果。因此，我们的研究结果对旨在纠正医生总数而不考虑专科医生对医疗保健结果影响的政策的有效性提出了质疑。
