Abstract
A comparison was made between the geographic distributions of physicians in Japan, the United States, and Britain. Regional variation in the number of primary care physicians per unit population was larger in Japan than in Britain. The results can probably be explained by differences in the primary care systems of the two countries. Next, we examined the effect of increased physician numbers overall on the geographic distribution of physicians in Japan and the US. In spite of constant growth in the numbers of physicians between 1980 and 2005, physicians did not diffuse according to the population distribution in both countries. Rather, US physicians seem to diffuse according to income distribution. This is probably due to the difference in health insurance systems between the two countries. In addition, physician scarcity was associated with further scarcity in US communities, while the scarcity was associated with recovery from scarcity in underserved Japanese communities. Political interventions to address the maldistribution of physicians apparently have not worked effectively in the US compared with Japan. Finally, we compared the number and distribution of specialists between Japan and the US. The lower the proportion of clinic-based physicians was, the lower the number of physicians and the lower the equity of physician distribution in Japanese specialties, while there was no association between the office-based rate and distribution equity in US specialties. In radiology, anaesthesiology, emergency medicine, and pathology, the numbers of physicians per unit population were less than half of the US values. Difficulty in being self-employed created low numbers and highly urban-biased distributions of some specialists in Japan. In conclusion, the uniqueness of the Japanese healthcare system potentially affects the geographic distribution of physicians in the country.
