Geographic distribution of physicians and teachers in Japan: what might we learn from the contrast between two workforce allocation systems?

Early Abstract:

Introduction: Equitable access to healthcare and education is recognised as a core human right in both the Constitution of Japan and international frameworks. However, the geographic distribution of professionals providing these services is governed by different institutional arrangements.
Methods: This descriptive study used data from the Ministry of Health, Labour and Welfare’s Statistics of Physicians, Dentists and Pharmacists 2020; the Ministry of Education, Culture, Sports, Science and Technology’s School Basic Survey 2023; and the Ministry of Internal Affairs and Communications’ Basic Resident Register 2023. The database linked the Japanese population with the number of physicians and teachers in 1,896 municipalities across Japan. Municipalities are classified into four administrative categories (metropolis, centre city, other city, and town/village) and are also grouped into four quartiles based on population density. These government-mandated censuses comprehensively cover practising physicians and schools, including private institutions, throughout Japan. Population-standardised indicators were used to compare geographic distribution patterns.
Results: The total numbers of physicians and teachers analysed in this study are 339,623 and 894,940, respectively. Physicians were more concentrated in metropolitan areas, whereas teachers were distributed more evenly or were relatively more numerous in less densely populated areas. The number of physicians per 100,000 people in metropolises is more than double that in towns and villages. In contrast, the number of teachers per 10,000 children in towns and villages is 1.4 to 1.6 times higher than in metropolises. Similar contrasting patterns were observed when areas were classified by population density quartiles.
Conclusions: This contrast highlights how different workforce allocation systems may shape the geographic availability of essential services. These findings should not, however, be interpreted as implying that one profession is more socially responsible than the other. The findings suggest that institutional arrangements, including public employment, assignment mechanisms, professional mobility, and financing structures, play a central role in shaping geographic workforce distribution. Although the teacher allocation framework cannot be directly applied to healthcare, it offers useful institutional points of comparison for health workforce policy. 
Keywords: geography, Japan, physicians, public policy, resource allocation, right to health, rural health services, school teachers.