The Impact of Pediatrician Supply on Child Health Outcomes: Longitudinal Evidence from Japan

Health Services Research - Tập 51 Số 2 - Trang 530-549 - 2016
Rie Sakai‐Bizmark1, Günther Fink2, Hiraku Kumamaru3,4, Ichiro Kawachi1
1Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
2Department of Global Health and Population, Harvard School of Public Health, Boston, MA
3Department of Epidemiology, Harvard School of Public Health, Boston, MA
4Department of Healthcare Quality Assessment, The University of Tokyo, Tokyo, Japan

Tóm tắt

ObjectiveTo investigate the effect of pediatrician supply on under‐5 mortality over the period 2000–2010.Data SourcesMultiple publicly available data sources were used.Study DesignJapan's 366 “Secondary Tier of Medical Care Units” (STMCU) were used as study units. To evaluate the association between under‐5 mortality and pediatrician supply, we explored time and area fixed‐effects Poisson regression model. The following factors were introduced into the models as time‐varying controls: (1) number of physicians other than pediatricians per total population except for under‐5‐year‐old population, and (2) income per total population by year and STMCU. Extensive sensitivity analyses were conducted to assess robustness of results.Principal FindingsPediatrician density was inversely associated with under‐5 mortality. We estimated that a unit increase in pediatrician density was associated with a 7 percent (95 percent CI: 2–12 percent) reduction in the child mortality rate after adjustment for all other variables. The results were consistent and robust across all specifications tested.ConclusionsThe results suggest that increasing human health resources can have positive effects on child health, even in settings where child mortality of less than 5 per 1,000 has been achieved.

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Health Services Research

Tập 51 Số 2

530-549

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