Trend in geographic distribution of physicians in Japan

<p>Abstract</p> <p>Background</p> <p>Since the late 1980s, the policy of the Japanese government regarding physician manpower has been to decrease the number of medical students. However, the shortage of doctors in Japan has become a social problem in recent years. The aim of this study was to compare the numbers of physicians in Japan between 1996 and 2006 and the trends in distribution of physicians.</p> <p>Methods</p> <p>The time trends in number and distribution of physicians between 1996 and 2006 were analyzed. Gini coefficient, Atkinson index and Theil index were used as measures for mal-distribution of physicians to population. The distribution of physicians was visualized on a map by using geographic information system (GIS) software.</p> <p>Results</p> <p>The total number of physicians increased every year in the period from 1996 to 2006 but has remained below the international standard. All three measures of mal-distribution of physicians worsened after 2004, and the worsening was remarkable in the distribution of physicians working at hospitals. The number of physicians working at hospitals has significantly increased in urban areas but not in areas with low population densities. When medical interns were excluded from calculation, the measures of mal-distribution improved.</p> <p>Conclusion</p> <p>The problem of a doctor shortage in Japan is linked to both the shortage of absolute number of physicians and the mal-distribution of hospital physicians. The new postgraduate internship system might worsen this situation.</p

Non-specialized inpatient care provided by university hospitals in Japan

In Japan, all citizens are covered by the national insurance system in which universal free access to healthcare services is promised to everybody. Even in tertiary care university hospitals, considerable numbers of secondary care inpatients are supposed to be treated. We studied the mixed state of secondary care and tertiary care in university hospitals in Japan and its year-to-year trend. Based on the results of a national survey, we could statistically classify Japanese case-mix classification into 821 groups that are supposed to need tertiary care (group A) and 296 groups that are supposed to need secondary care (group B). Sixty percent of patients admitted to the university hospitals belonged to group A, and 25% belonged to group B. Despite of the implementation of government policies to differentiate functions of hospitals, there was no trend toward an increase in the rate of tertiary care and decrease in the rate of secondary care from 2003 to 2006. Patient behavior to seek tertiary care was simply influenced by distance from university hospital. However, behavior of patients to seek secondary care was significantly influenced by distance to adjacent general hospitals and seize of these hospitals

Experimental Test of a New Equality: Measuring Heat Dissipation in an Optically Driven Colloidal System

Measurement of energy dissipation in small nonequilibrium systems is generally a difficult task. Recently, Harada and Sasa [Phys.Rev.Lett. 95, 130602(2005)] derived an equality relating the energy dissipation rate to experimentally accessible quantities in nonequilibrium steady states described by the Langevin equation. Here, we show the first experimental test of this new relation in an optically driven colloidal system. We find that this equality is validated to a fairly good extent, thus the irreversible work of a small system is estimated from readily obtainable quantities.Comment: 4 pages, 6 figure

Efficiency of Free Energy Transduction in Autonomous Systems

We consider the thermodynamics of chemical coupling from the viewpoint of free energy transduction efficiency. In contrast to an external parameter-driven stochastic energetics setup, the dynamic change of the equilibrium distribution induced by chemical coupling, adopted, for example, in biological systems, is inevitably an autonomous process. We found that the efficiency is bounded by the ratio between the non-symmetric and the symmetrized Kullback-Leibler distance, which is significantly lower than unity. Consequences of this low efficiency are demonstrated in the simple two-state case, which serves as an important minimal model for studying the energetics of biomolecules.Comment: 4 pages, 4 figure