Empirical Studies on the Uneven Distribution of Physicians

2018 Fiscal Year Final Research Report

• Project/Area Number: 26285064
• Research Category: Grant-in-Aid for Scientific Research (B)
• Allocation Type: Partial Multi-year Fund
• Section: 一般
• Research Field: Public finance/Public economy
• Research Institution: The University of Tokyo
• Principal Investigator: Iizuka Toshiaki 東京大学, 大学院経済学研究科(経済学部), 教授 (00406810)
• Research Collaborator: WATANABE Yasutora ; NISHIYAMA Katsuhiko
• Project Period (FY): 2014-04-01 – 2019-03-31
• Keywords: 医師不足 / 医師偏在 / 医師分布 / キャリア形成 / 構造推計 / 新臨床研修制度

Outline of Final Research Achievements

In recent years, shortage and uneven distribution of physicians have become major social problems in Japan. In this study, three related issues were empirically analyzed using physician survey data. First, we analyzed the factors that influence the physician's choice of working as a hospital doctor or opening an own clinic using the physician long-term panel data and dynamic structural estimation model. Also, using the estimated model, we examined the effect of the policy for eliminating the uneven distribution of physicians. Second, we analyzed the impact of the new clinical training system introduced in Japan in 2004 on i) physician distribution, ii) physician wages, iii) hospital exit, and iv) medical outcomes. Third, we modeled the entry of physicians into small towns and analyzed the factors of the geographical distribution of physicians. In addition, using the estimated model, we analyzed how provider payments and aging population affect the distribution of physicians.

Free Research Field

医療経済学

Academic Significance and Societal Importance of the Research Achievements

近年我が国においては、医師不足・医師偏在が大きな社会的問題として取り上げられてきた。2000年以降、マスメディア等では地方における「医療崩壊」として、特に地方における産科・小児科・救命救急に従事する医師の不足や偏在が取り上げられ、厚生労働省の調査（平成22年度）によると全国で14%の医師が不足しているとされた。更なる高齢化の進行及びそれに伴なう医療サービス需要の増加、少子化対策としての産科・小児科医療の重要性等を考えると、医師不足・医師偏在とそれに伴う医療の質の低下は今後も国民生活の質に直結する大きな政策的課題であり続ける可能性が高く、医師不足・医師偏在の要因と解決策の分析は社会的意義が高い。