医師供給の不足が医師の地理的偏在を悪化させる？：広島県と長崎県の比較

Figure 1:競争原理を取り入れた医師の分布モデル　クリックで拡大
Figure 1:競争原理を取り入れた医師の分布モデル　クリックで拡大

Matsumoto M, Inoue K, Kashima S, Takeuchi K.  Does the insufficient supply of physicians worsen their urban-rural distribution? A Hiroshima-Nagasaki comparison. Rural and Remote Health 12: 2085. (Online) 2012. Available: http://www.rrh.org.au 

 

Introduction:  Studies have suggested that a rapid increase in physicians does not necessarily change an urban and rural inequity in their distribution. However, it is unknown whether an insufficient supply of physicians worsens an inequity. Spatial competition and attraction and repulsion hypotheses were applied to the geographic distribution of physicians during a time of insufficient physician supply in Japan.
Methods:  Trends of physician distribution as well as urban睦ural physician flow were compared using Hiroshima Prefecture which had the lowest increase in physician-to-population ratios between 2002 and 2008 (2.7%), and Nagasaki Prefecture where the increase was one of the highest (12.0%) among the 47 Japanese prefectures.
Results:  The Gini coefficient of physicians compared with population in Hiroshima increased by 4.1%. Movement toward inequity was greater in Hiroshima compared with Nagasaki where the increase was 2.5%. Approximately 245 physicians or 18.8% moved from rural to urban locations in Hiroshima compared with 143 (14.6%) for Nagasaki (p=0.01). In contrast, 228 (7.6%) urban physicians moved to rural areas in Hiroshima compared with 175 (11.6%) in Nagasaki (p<0.001).
Conclusions: In a time of insufficient supply of physicians, a region with a smaller increase in physicians may experience worsening of the urban睦ural distribution of physicians compared with a region where there is a more rapid increase in physicians. One strategy for achieving a more equitable distribution of physicians is to increase in the physician supply relative to demand in order to stimulate competition among urban physicians and maintain the power equilibrium between attraction-to and repulsion-from urban areas.

 

Comments by Inoue Methods founder

医師数のあまり増えない地域（この場合都道府県）では、医師を都市部から非都市部へ赴かせる力（本論文ではrepulsion）が弱い。そのために医師の地理的偏在が悪化するのではないかと提唱した論文。本論文の直接内容ではないが、現在のように相対的にどこでも医師が足りないとされる現状の日本では、repulsionは弱く、市場論理が働かないのかもしれない。

僻地への移動にかかわる医師特性：広島県における経時的研究

Matsumoto M, Inoue K, Kashima S, Takeuchi K.  Characteristics of physicians, their migration patterns and distance: a longitudinal study in Hiroshima, Japan.Rural and Remote Health 12: 2027. (Online) 2012. Available: http://www.rrh.org.au

 

Introduction:Although some characteristics of physicians are known to be associated with their recruitment in rural and remote areas, the factors that predict mobility of physicians, and in particular, their mobility to rural and distant areas are largely unknown.
Methods:Flows of all physicians (n=4268) among municipalities in Hiroshima Prefecture, Japan, between 2002 and 2008 were analysed. Physician data were obtained from the National Physician Census.Municipality-level population data derived from the National Basic Resident Register were merged with the physician data. Information on the road distances of two municipalities measured with a geographic information system (GIS) was added to the physician cohort.
Results:During the period of study, 24.8% of physicians crossed municipal borders, and among them, 66.6% moved distances of less than 60min travel time. The number of migrated physicians decreased as the distance increased, which held true for both migration to urban and rural areas. In the univariate analysis, female, younger, and hospital physicians were more mobile to rural areas than were male, older, and clinic physicians.Male and younger (≤40years) physicians moved a longer distance than female and older physicians.Multivariate analysis revealed that age was a negative predictor (odds ratio [OR] per 10years 0.62, 95% confidence interval [CI] 0.55-0.70]), and affiliation with a hospital was a positive predictor of migration to rural areas (OR 6.19 [95% CI 4.21-9.10]).Male sex (OR 1.67 [95% CI 1.11-2.50]) and hospital affiliation (OR 5.61 [95% CI 3.33-9.45]) were positive predictors, and age (OR per 10years 0.39 [95% CI 0.33-0.46]) was a negative predictor of migrating a long distance.
Conclusion:In order to attract physicians to rural and remote areas, health workforce policies need to set a target population of physicians who are highly mobile to such places. Combining known predictors of rural practice, such as physicians with rural background and primary care physicians, and the mobility predictors shown in this study (ieyoung, hospital and male physicians) would make the target more appropriate and policies more effective.

Key words: geographic information systems, geography, manpower, medically underserved area, physicians, rural Japan, supply and distribution.

 

Comments by Inoue Methods founder

GISを用いて医師の勤務にかかわる移動（居住地から勤務地への）の様相と医師の特性の関わりを見たものである。医師が家族を引き連れて非都市部へ転勤するという状況が生まれにくいとすれば、家族は都市部に残しつつも、長距離を移動して非都市部で勤務する医師についても着目するべきであろう。

 

Comments by Matsumoto (First author)

検証している仮説が世界中で成り立ちうるものであれば、広島や長崎のローカル・データでもじゅうぶん国際誌に通用するという一例だと思います。