Geographical distribution improvement of physicians in Thailand and Japan : a comparative longitudinal secondary data analysis

Abstract

Background: The equitable distribution of healthcare workforces to all citizens is necessary to achieve health for all, and has been discussed and addressed in all countries including Thailand and Japan. The objective of this study was to longitudinally examine the change in the geographical distribution of physicians and related policies between 2008 and 2018 through a comparison between Thailand and Japan.

Methodology: This research was a longitudinal comparative descriptive study. All data is open secondary data that can be downloaded in the government website. The number of physicians, the physician-population ratio, the Gini coefficient and the Spearman’s correlation coefficient between population density and physician-population ratio in 2008 and 2018 were calculated and compared among Thailand and Japan. As a subgroup analysis, all 76 provinces in Thailand and 335 secondary medical areas in Japan were divided into four groups according to two criteria: urban-rural and higher-lower initial physician supply classification. Related educational and healthcare policies were also compared.

Result: During the decade, the Gini coefficient was improved from 0.372 to 0.319, and from 0.217 to 0.211 in Thailand and Japan, respectively. The correlation coefficient in Thailand was 0.168 and 0.181 in 2008 and 2018, respectively with no statistical significance. In Japan, the correlation coefficient was 0.368 and 0.405 in 2008 and 2018, respectively with statistical significance. As for the subgroup analyses, the number of physicians in Thailand was increased by 1.97-1.99 and 1.55-1.74 times for the groups with higher and lower initial physician supply, respectively. While one in Japan was increased by 1.10-1.17 and 0.99-1.00 times for the urban and rural groups, respectively. The existence of mandatory rural service for all medical school graduates was one of the biggest differences among countries.

Conclusion: This comparative study revealed that Thailand relatively successfully allocated physicians to physician shortage areas. It was also suggested that Thai educational system may be more effective in mitigating the geographic maldistribution of physicians, while Japanese background systems may be more effective in preventing the geographical maldistribution of physicians from occurring. To implement political intervention, it is necessary to determine how many physicians in which areas and fields are in short supply. It is then necessary to implement policies in a way that is suitable for each country’s context and existing systems.