Evaluating the effect of Japan’s 2004 postgraduate training programme on the spatial distribution of physicians

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• 作者：Rie Sakai (1) (2) (3)
  Hiroshi Tamura (4) (5)
  Rei Goto (6) (7)
  Ichiro Kawachi (1)
  
  1. Department of Social and Behavioural Sciences ; Harvard School of Public Health ; 677 Huntington Avenue ; Boston ; MA ; 02215 ; USA
  2. Department of Medical Education ; Juntendo University School of Medicine ; Hongo 2-1-1 Bunkyo-ku ; Tokyo ; Japan
  3. Department of Paediatrics and Adolescent Medicine ; Juntendo University School of Medicine ; Hongo 2-1-1 Bunkyo-ku ; Tokyo ; Japan
  4. Division of Medical Information Technology and Administration Planning ; Kyoto University Hospital ; Sakyo-ku ; Kyoto City ; Kyoto ; 606-8507 ; Japan
  5. Department of Ophthalmology and Visual Sciences ; Kyoto University Graduate School of Medicine ; Sakyo-ku ; Kyoto City ; Kyoto ; 606-8507 ; Japan
  6. Hakubi Centre of Advanced Research ; Kyoto University ; Sakyo-ku ; Kyoto City ; Kyoto ; 606-8501 ; Japan
  7. Graduate School of Economics ; Kyoto University ; Yoshida ; Sakyo-ku ; Kyoto ; Japan
  
• 关键词：Human resources ; Physician distribution ; Postgraduate medical training programme ; Japan
• 刊名：Human Resources for Health
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：13
• 期：1
• 参考文献：1. Ministry of Health. Labor and Welfare. Reform of Postgraduate Medical Training Prgram [in Japanese]. Accessed 2 April 2013 http://www.mhlw.go.jp/topics/bukyoku/isei/rinsyo/hensen/index.html
  2. Ministry of Health. Labor and Welfare: / About the New Postgraduate Training Program. [in Japanese]. Accessed 2 April 2013 http://www.mhlw.go.jp/topics/bukyoku/isei/rinsyo/keii/dl/021022a.pdf
  3. Ministry of Health, Labour and Welfare: / Recruitment record of residents. [in Japanese]. Accessed 19 May 2012 5-2d.pdf" class="a-plus-plus">http://www.mhlw.go.jp/topics/bukyoku/isei/rinsyo/matching/dl/100915-2d.pdf
  4. Ministry of Health, Labour and Welfare: / Outline of postgraduate clinical training. Conference paper presented at Working Group on Postgraduate Clinical Training. [in Japanese]. Accessed 7 September 2014 http://www.mhlw.go.jp/shingi/0106/s0601-1.html#s2-1
  5. Ministry of Health, Labor and Welfare: / Review of the postgraduate training program. [in Japanese]. Accessed 17 February 2013 http://www.mhlw.go.jp/seisaku/2009/08/04.html
  6. Mori K: / Report about inequality in physician distribution and physician shortage: did the new postgraduate medical training program implemented in 2004 expose physician shortage?. [in Japanese]. Accessed 10 October 2014 http://www.jmari.med.or.jp/download/WP166.pdf
  7. Sakai R, Fink G, Kawachi I: Pediatricians-practice location choice-evaluating the effect of Japan’s 2004 postgraduate training program on the spatial distribution of pediatricians. / J Epidemiol 2014,24(3):239-9. 10.2188/jea.JE20130117 CrossRef
  8. Toyabe S: Trend in geographic distribution of physicians in Japan. / Int J Equity Health 2009, 8:5. 10.1186/1475-9276-8-5 5-9276-8-5" target="_blank" title="It opens in new window">CrossRef
  9. Matsumoto M, Inoue K, Noguchi S, Toyokawa S, Kajii E: Community characteristics that attract physicians in Japan: a cross-sectional analysis of community demographic and economic factors. / Hum Resour Health 2009, 7:12. 10.1186/1478-4491-7-12 CrossRef
  10. Odisho AY, Fradet V, Cooperberg MR, Ahmad AE, Carroll PR: Geographic distribution of urologists throughout the United States using a county level approach. / J Urol 2009,181(2):760-. discussion 765- 10.1016/j.juro.2008.10.034 CrossRef
  11. Ono K, Hiratsuka Y, Murakami A: Geographical distribution of ophthalmologists before and after the new postgraduate training program in Japan. / Ophthalmic Epidemiol 2010,17(2):125-0. 10.3109/09286581003624988 581003624988" target="_blank" title="It opens in new window">CrossRef
  12. Kobayashi Y, Takaki H: Geographic distribution of physicians in Japan. / Lancet 1992,340(8832):1391-. 10.1016/0140-6736(92)92569-2 569-2" target="_blank" title="It opens in new window">CrossRef
  13. Matsumoto M, Inoue K, Bowman R, Noguchi S, Toyokawa S, Kajii E: Geographical distributions of physicians in Japan and US: impact of healthcare system on physician dispersal pattern. / Health Policy 2010,96(3):255-1. 10.1016/j.healthpol.2010.02.012 healthpol.2010.02.012" target="_blank" title="It opens in new window">CrossRef
  14. Matsumoto M, Inoue K
• 刊物主题：Health Administration; Social Policy;
• 出版者：BioMed Central
• ISSN：1478-4491

文摘

Background In 2004, the Japanese government permitted medical graduates for the first time to choose their training location directly through a national matching system. While the reform has had a major impact on physicians-placement, research on the impact of the new system on physician distribution in Japan has been limited. In this study, we sought to examine the determinants of physicians-practice location choice, as well as factors influencing their geographic distribution before and after the launch of Japan’s 2004 postgraduate medical training programme. Methods We analyzed secondary data. The dependent variable was the change in physician supply at the secondary tier of medical care in Japan, a level which is roughly comparable to a Hospital Service Area in the US. Physicians were categorized into two groups according to the institutions where they practiced; specifically, hospitals and clinics. We considered the following predictors of physician supply: ratio of physicians per 1,000 population (physician density), age-adjusted mortality, 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. Results Baseline physician density showed a positive association with the change in physician supply after the launch of the 2004 programme (P-value P-value = .026), whereas a positive association was found after 2004 (P-value P-values P-value = .015) and area-level socioeconomic status was not correlated. Conclusion Following the introduction of the 2004 postgraduate training programme, physicians in Japan were more likely to move to areas with already high physician density and urban locations. These changes worsened regional inequality in physician supply, particularly hospital doctors.