Improving the medical services of rural hospitals by reforming the JRMP mechanism

2019 Fiscal Year Final Research Report

• Project/Area Number: 16K03561
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Economic theory
• Research Institution: Waseda University
• Principal Investigator: Toda Manabu 早稲田大学, 社会科学総合学術院, 教授 (30217509)
• Co-Investigator(Kenkyū-buntansha): 笠島 洋一 早稲田大学, 社会科学総合学術院, 准教授 (30583166)
• Project Period (FY): 2016-04-01 – 2020-03-31
• Keywords: 医師臨床研修マッチング / 過疎地医療

Outline of Final Research Achievements

We consider to subsidize rural hospitals with unfilled quotas to encourage doctors to apply them in the JRMP mechanism. The current rule of the program is the deferred acceptance, which determines the stable matching the most preferred by doctors, aiming at the fairness among them. However, in the stable matching, the quotas of some hospitals possibly remain to be unfilled, which may result in the shortage of medical services in local towns and villages. A possible solution is to place upper bounds on the total numbers of seats offered by urban hospitals but it may reduce the welfare of the doctors. Instead, we analyze the effects of subsidizing rural hospitals to encourage the applicants. Under the current rule of Japan, it has been shown that the subsidy is harmless for all doctors but there exists no stable mechanism in which the subsidy is harmless for all hospitals. We also obtained a new set of axioms characterizing the set of all stable matchings.

Free Research Field

理論経済学

Academic Significance and Societal Importance of the Research Achievements

平成16年以降に導入された医師臨床研修マッチングでは地域間で研修医の偏在が生じることが問題となった．そこで近年応募多数となる地域の採用数に上限を設けることで地域間格差の解消が図られている．しかし上限導入後，医師側の厚生は悪化し第1希望以外への配属数が増加している．本研究はそれに代えて過疎地の研修機関に対する補助金等の効果を分析した．現行制度は医師の公平性を重視して設計されており補助金の支出が医師全員にとって同じ意味を持つか否かは必ずしも明らかではない．我々は現行制度下での補助金は医師側にとり常に無害であると同時に研修機関に対しては同一の影響を与えるような制度そのものが存在しないことを示した．