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Physician scarcity is a predictor of further scarcity in US, and a predictor of concentration in Japan

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  • Matsumoto, Masatoshi
  • Inoue, Kazuo
  • Bowman, Robert
  • Noguchi, Satomi
  • Kajii, Eiji

Abstract

Objectives To assess the effects of geographic diffusion of physicians from medically oversupplied toward undersupplied areas driven by economic competition among physicians and political interventions in Japan and US.Methods A quantitative evaluation of physician workforce changes at the community level between 1980 and 2005, using municipality-based (Japan) and county-based (US) census data.Results The overall number of physicians per 100,000 population (physician-to-population ratio: PPR) increased from 130 to 203 in Japan and 158 to 234 in US. In this context, a higher proportion (30.1%) of the quintile communities with lowest PPRs in 1980 has further decreased their PPRs in US than in Japan (21.6% in 2005). In multivariate analysis low PPR was a positive predictor of PPR decrease in the US communities (odds ratio 1.26; 95% confidence interval 1.01-1.58), while it was a negative predictor in Japanese communities (0.69; 0.57-0.83).Conclusions Physician scarcity is associated with further scarcity in US communities, while scarcity is associated with recovery from scarcity in Japanese communities. Competition-based physician diffusion strategies and various interventions to address the maldistribution of physicians apparently have not worked effectively in US compared with Japan.

Suggested Citation

  • Matsumoto, Masatoshi & Inoue, Kazuo & Bowman, Robert & Noguchi, Satomi & Kajii, Eiji, 2010. "Physician scarcity is a predictor of further scarcity in US, and a predictor of concentration in Japan," Health Policy, Elsevier, vol. 95(2-3), pages 129-136, May.
    • Handle: RePEc:eee:hepoli:v:95:y:2010:i:2-3:p:129-136
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    References listed on IDEAS

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    1. Matsumoto, Masatoshi & Kajii, Eiji, 2009. "Medical education program with obligatory rural service: Analysis of factors associated with obligation compliance," Health Policy, Elsevier, vol. 90(2-3), pages 125-132, May.
    2. Joseph P. Newhouse & Albert P. Williams & Bruce W. Bennett & William B. Schwartz, 1982. "Does the Geographical Distribution of Physicians Reflect Market Failure?," Bell Journal of Economics, The RAND Corporation, vol. 13(2), pages 493-505, Autumn.
    3. Brown, Malcolm C., 1994. "Using gini-style indices to evaluate the spatial patterns of health practitioners: Theoretical considerations and an application based on Alberta data," Social Science & Medicine, Elsevier, vol. 38(9), pages 1243-1256, May.
    4. Frenzen, P.D., 1991. "The increasing supply of physicians in US urban and rural areas, 1975 to 1988," American Journal of Public Health, American Public Health Association, vol. 81(9), pages 1141-1147.
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    2. Koichiro Yuji & Seiya Imoto & Rui Yamaguchi & Tomoko Matsumura & Naoko Murashige & Yuko Kodama & Satoru Minayo & Kohzoh Imai & Masahiro Kami, 2012. "Forecasting Japan's Physician Shortage in 2035 as the First Full-Fledged Aged Society," PLOS ONE, Public Library of Science, vol. 7(11), pages 1-8, November.

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