IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v71y2010i4p667-671.html
   My bibliography  Save this article

Policy implications of a financial incentive programme to retain a physician workforce in underserved Japanese rural areas

Author

Listed:
  • Matsumoto, Masatoshi
  • Inoue, Kazuo
  • Kajii, Eiji

Abstract

Existing evidence supports the effectiveness of a financial incentive policy for medical students and early-career physicians in return for obligatory rural service. But whether the experience of contractual rural service affects the physician's choice of practice location after the service is completed remains unknown. This study analysed the practice location of Jichi Medical University (JMU) graduates. JMU is a Japanese medical education programme with a contract system under which all graduates have an obligation to serve in underserved areas for about six years in exchange for a 6-year undergraduate tuition waiver. 484 JMU graduates who were under rural service in 2000 and had completed the service by 2006 were included in the study. The rurality of the communities was determined by population density quintiles. The proportion of those practicing in the communities with the highest rurality quintile in 2000 (30.8%) decreased dramatically (8.7%) in 2006, but the geographic distribution of the participants after contract was still biased toward rural areas compared with the distribution pattern of all Japanese physicians. The flow of participants from rural to urban communities was largely unidirectional. In 2006, 452 (93.4%) practiced in places with the same or lower rurality than in 2000, while only 32 (6.6%) practiced in places with higher rurality as compared to the placements of 2000. Multivariate analysis showed that service experience in the communities of the first and second highest quintiles of rurality was associated with choosing such places after contract, independent of known predictors of rural practice, such as having a rural background and primary care specialty choice. Although the effect of contractual rural service substantially decreased after finishing the service, the experience of rural service early in the physician's career had a positive impact on the later choice of a rural practice. The results from this study support the use of a policy that attracts early-career physicians to practice in rural areas.

Suggested Citation

  • Matsumoto, Masatoshi & Inoue, Kazuo & Kajii, Eiji, 2010. "Policy implications of a financial incentive programme to retain a physician workforce in underserved Japanese rural areas," Social Science & Medicine, Elsevier, vol. 71(4), pages 667-671, August.
    • Handle: RePEc:eee:socmed:v:71:y:2010:i:4:p:667-671
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(10)00388-6
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Matsumoto, Masatoshi & Kajii, Eiji, 2009. "Medical education program with obligatory rural service: Analysis of factors associated with obligation compliance," Health Policy, Elsevier, vol. 90(2-3), pages 125-132, May.
    2. Ugalde, Antonio, 1984. "Where there is a doctor: Strategies to increase productivity at lower cost. The economics of rural health care in the Dominican Republic," Social Science & Medicine, Elsevier, vol. 19(4), pages 441-450, January.
    3. Cavender, Anthony & Albán, Manuel, 1998. "Compulsory medical service in Ecuador: the physician's perspective," Social Science & Medicine, Elsevier, vol. 47(12), pages 1937-1946, December.
    4. Till Bärnighausen & David E. Bloom, 2008. "Financial incentives for return of service in underserved areas: a systematic review," PGDA Working Papers 3608, Program on the Global Demography of Aging.
    5. Anderson, Malcolm & Rosenberg, Mark W., 1990. "Ontario's underserviced area program revisited: An indirect analysis," Social Science & Medicine, Elsevier, vol. 30(1), pages 35-44, January.
    6. Matsumoto, Masatoshi & Inoue, Kazuo & Kajii, Eiji, 2008. "Characteristics of medical students with rural origin: Implications for selective admission policies," Health Policy, Elsevier, vol. 87(2), pages 194-202, August.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Burcay Erus & Ayca Bilir, 2015. "Obligatory service requirement and physician specialist distribution in Turke," Economics Bulletin, AccessEcon, vol. 35(1), pages 441-451.
    2. Jamil Rossilah, 2021. "Human Resources Perspectives In Resourcing Medical Doctors For Rural Areas," Management Theory and Studies for Rural Business and Infrastructure Development, Sciendo, vol. 43(4), pages 562-573, December.
    3. Feder-Bubis, Paula & Bin-Nun, Gabi & Zarhin, Dana & Sherf, Michael & Heiman-Neuman, Nitza, 2023. "Residents' choice of a placement in periphery hospitals in Israel: The significance of personal/family and professional considerations," Health Policy, Elsevier, vol. 132(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. McGrail, Matthew R. & Humphreys, John S. & Joyce, Catherine M. & Scott, Anthony, 2012. "International medical graduates mandated to practise in rural Australia are highly unsatisfied: Results from a national survey of doctors," Health Policy, Elsevier, vol. 108(2), pages 133-139.
    2. Feder-Bubis, Paula & Bin-Nun, Gabi & Zarhin, Dana & Sherf, Michael & Heiman-Neuman, Nitza, 2023. "Residents' choice of a placement in periphery hospitals in Israel: The significance of personal/family and professional considerations," Health Policy, Elsevier, vol. 132(C).
    3. Burcay Erus & Ayca Bilir, 2015. "Obligatory service requirement and physician specialist distribution in Turke," Economics Bulletin, AccessEcon, vol. 35(1), pages 441-451.
    4. Till Bärnighausen & David E. Bloom, 2008. "Designing financial-incentive programmes for return of medical service in underserved areas of sub-Saharan Africa," PGDA Working Papers 3708, Program on the Global Demography of Aging.
    5. Michel Grignon & Yaw Owusu & Arthur Sweetman, 2013. "The international migration of health professionals," Chapters, in: Amelie F. Constant & Klaus F. Zimmermann (ed.), International Handbook on the Economics of Migration, chapter 4, pages 75-97, Edward Elgar Publishing.
    6. Halah Ibrahim & Fatema Zain Al Sharif & Karthyayani Priya Satish & Lina Hassen & Satish Chandrasekhar Nair, 2019. "Should I stay or should I go now? The impact of “pull” factors on physician decisions to remain in a destination country," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1909-1920, October.
    7. Holte, Jon Helgheim & Kjaer, Trine & Abelsen, Birgit & Olsen, Jan Abel, 2015. "The impact of pecuniary and non-pecuniary incentives for attracting young doctors to rural general practice," Social Science & Medicine, Elsevier, vol. 128(C), pages 1-9.
    8. Till Bärnighausen & David E. Bloom & Salal Humair, 2009. "A Mathematical Model for Estimating the Number of Health Workers Required for Universal Antiretroviral Treatment," PGDA Working Papers 5209, Program on the Global Demography of Aging.
    9. Johns, Benjamin & Steinhardt, Laura & Walker, Damian G. & Peters, David H. & Bishai, David, 2013. "Horizontal equity and efficiency at primary health care facilities in rural Afghanistan: A seemingly unrelated regression approach," Social Science & Medicine, Elsevier, vol. 89(C), pages 25-31.
    10. J R Barnett, 1993. "Does the Geographic Distribution of Physicians Reflect Market Failure?: An Examination of the New Zealand Experience, 1981–87," Environment and Planning A, , vol. 25(6), pages 827-846, June.
    11. Jonas Minet Kinge & Jostein Grytten, 2021. "The impact of primary care physician density on perinatal health: Evidence from a natural experiment," Health Economics, John Wiley & Sons, Ltd., vol. 30(12), pages 2974-2994, December.
    12. Luiz Felipe Campos Fontes & Otavio Canozzi Conceição & Paulo de Andrade Jacinto, 2018. "Evaluating the impact of physicians' provision on primary healthcare: Evidence from Brazil's More Doctors Program," Health Economics, John Wiley & Sons, Ltd., vol. 27(8), pages 1284-1299, August.
    13. Till Bärnighausen & David Bloom, 2009. "Changing Research Perspectives on the Global Health Workforce," PGDA Working Papers 4609, Program on the Global Demography of Aging.
    14. Till Bärnighausen & David E. Bloom & Salal Humair, 2008. "Estimating health worker need to provide antiretroviral treatment in the developing world," PGDA Working Papers 3808, Program on the Global Demography of Aging.
    15. Scott, Anthony & Witt, Julia & Humphreys, John & Joyce, Catherine & Kalb, Guyonne & Jeon, Sung-Hee & McGrail, Matthew, 2013. "Getting doctors into the bush: General Practitioners' preferences for rural location," Social Science & Medicine, Elsevier, vol. 96(C), pages 33-44.
    16. Matsumoto, Masatoshi & Inoue, Kazuo & Bowman, Robert & Noguchi, Satomi & Kajii, Eiji, 2010. "Physician scarcity is a predictor of further scarcity in US, and a predictor of concentration in Japan," Health Policy, Elsevier, vol. 95(2-3), pages 129-136, May.
    17. Paterson, Marie & Green, Maryann & Maunder, Eleni M.W., 2007. "Running before we walk: How can we maximise the benefits from community service dietitians in KwaZulu-Natal, South Africa?," Health Policy, Elsevier, vol. 82(3), pages 288-301, August.
    18. Mandeville, Kate L. & Hanson, Kara & Muula, Adamson S. & Dzowela, Titha & Ulaya, Godwin & Lagarde, Mylène, 2017. "Specialty training for the retention of Malawian doctors: A cost-effectiveness analysis," Social Science & Medicine, Elsevier, vol. 194(C), pages 87-95.
    19. Pieter Serneels & Abigail Barr & Magnus Lindelow, 2005. "Understanding Geographical Imbalances in the Health Workforce," Economics Series Working Papers GPRG-WPS-018, University of Oxford, Department of Economics.
    20. Siegel, Martin & Koller, Daniela & Vogt, Verena & Sundmacher, Leonie, 2016. "Developing a composite index of spatial accessibility across different health care sectors: A German example," Health Policy, Elsevier, vol. 120(2), pages 205-212.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:71:y:2010:i:4:p:667-671. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.