Abstract
In post-war Japan, a number of factors lead to a general shortage of physicians by the 1950s, which became acute in rural areas and has continued until recent times. Teamwork among national, prefectural, municipal governments and public medical schools has addressed this shortage of physicians. The national government doubled the number of medical schools in the 1960s and 1970s; each of the country's 47 prefectures, whether rural or not, has at least one medical school. In rural areas where private hospitals are not profitable, municipal governments have funded public hospitals and physician recruitment from their own budgets. A cooperative project among Japan's 47 prefectural governments and the national government established Jichi Medical University (JMU), which conducts a bound medical education program followed by obligatory rural service. As a result, the number of 'non-physician communities' (muichiku) nationwide has decreased by 73%; however, the gap between physician concentrations in urban and rural areas has not changed. Therefore, the government has recently implemented a JMU-like contractual program as a form of 'rural quota' at other medical schools in all 47 prefectures. If all the replicated programs work as successfully as JMU, the impact on the geographic distribution of physicians will be substantial. The Japanese public-sector-led rural physician securing system could also be effective in countries where rural healthcare provision is the responsibility of the public sector and close cooperation among levels of government is possible.
Highlights
In order to achieve the ‘Health for All’ proposed by the Alma-Ata Declaration, a fair allocation of physicians among the entire population of each society is required[1]
Issue In Japan the mal-distribution of physicians that severely disadvantaged rural populations has been addressed by the concerted, cooperative efforts of the three public sectors: national government, local governments and medical schools
While the national government increased the number of medical schools and physicians, the governments of rural prefectures and municipalities that are directly responsible for providing health care to their residents, struggled to recruit physicians
Summary
Article 25 of the Constitution of Japan states that all people have a right to medical service of equal quality. While the national government increased the number of medical schools and physicians, the governments of rural prefectures and municipalities that are directly responsible for providing health care to their residents, struggled to recruit physicians. Despite these municipal and prefectural efforts, physician posts in rural medical institutions remained unfilled, with an occupancy rate of only 56% in 196715. The JMU has two unique characteristics: free medical education in exchange for obligatory rural service; and close, long-term cooperation of national and local governments, and the medical school over the period from pre-entrance selection to completion of the nine-year obligation for each student. The retention rate of JMU graduates in their home prefectures after obligation is 70%19
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