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. 2017 Sep 12;15(1):64.
doi: 10.1186/s12960-017-0238-8.

Forecasting the regional distribution and sufficiency of physicians in Japan with a coupled system dynamics-geographic information system model

Tomoki Ishikawa  1   2 , Kensuke Fujiwara  1 , Hisateru Ohba  3 , Teppei Suzuki  2 , Katsuhiko Ogasawara  4
Affiliations

Forecasting the regional distribution and sufficiency of physicians in Japan with a coupled system dynamics-geographic information system model

Tomoki Ishikawa et al. Hum Resour Health. .

Abstract

Background: In Japan, the shortage of physicians has been recognized as a major medical issue. In our previous study, we reported that the absolute shortage will be resolved in the long term, but maldistribution among specialties will persist. To address regional shortage, several Japanese medical schools increased existing quota and established "regional quotas." This study aims to assist policy makers in designing effective policies; we built a model for forecasting physician numbers by region to evaluate future physician supply-demand balances.

Methods: For our case study, we selected Hokkaido Prefecture in Japan, a region displaying disparities in healthcare services availability between urban and rural areas. We combined a system dynamics (SD) model with geographic information system (GIS) technology to analyze the dynamic change in spatial distribution of indicators. For Hokkaido overall and for each secondary medical service area (SMSA) within the prefecture, we analyzed the total number of practicing physicians. For evaluating absolute shortage and maldistribution, we calculated sufficiency levels and Gini coefficient. Our study covered the period 2010-2030 in 5-year increments.

Results: According to our forecast, physician shortage in Hokkaido Prefecture will largely be resolved by 2020. Based on current policies, we forecast that four SMSAs in Hokkaido will continue to experience physician shortages past that date, but only one SMSA would still be understaffed in 2030.

Conclusion: The results show the possibility that diminishing imbalances between SMSAs would not necessarily mean that regional maldistribution would be eliminated, as seen from the sufficiency levels of the various SMSAs. Urgent steps should be taken to place doctors in areas where our forecasting model predicts that physician shortages could occur in the future.

Keywords: Forecasting; Maldistribution; Physician shortage; Physicians; System dynamics.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Location of Hokkaido within Japan; each secondary medical service area (SMSA) in Hokkaido
Fig. 2
Fig. 2
Physician numbers in Hokkaido and Japan
Fig. 3
Fig. 3
Conceptual scheme of the Japanese physician career path
Fig. 4
Fig. 4
Stock and flow diagram of forecasting model based on career path
Fig. 5
Fig. 5
Visualizing the forecasted sufficiency level by SMSA
See this image and copyright information in PMC

References

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