文章基本信息

标题：Pediatricians’ Practice Location Choice—Evaluating the Effect of Japan’s 2004 Postgraduate Training Program on the Spatial Distribution of Pediatricians
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作者：Rie Sakai ; Günther Fink ; Ichiro Kawachi 等
期刊名称：Journal of Epidemiology
印刷版ISSN：0917-5040
电子版ISSN：1349-9092
出版年度：2014
卷号：24
期号：3
页码：239-249
DOI：10.2188/jea.JE20130117
出版社：Japan Epidemiological Association
摘要：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.
关键词：human resources;physician distribution;postgraduate medical training program;Japan