Author:
Matsumoto Masatoshi,Aikyo Tatsuki
Abstract
The geographically inequitable distribution of physicians has long posed a serious social problem in Japan. The government tackled this problem by establishing and managing Jichi Medical University (JMU) and regional quotas (RQs) for medical schools. JMU/RQs recruit local students who hope to work as physicians in rural areas, educate them for 6 years without tuition (JMU) or with scholarship (RQs), and after graduation, assign them to their home prefectures for 9 years, including 4–6 years of rural service. JMU/RQs entrants now occupy 11.6% of all medical school entrants. While JMU/RQs have been shown to be highly effective in securing physicians for rural areas, ethical issues related to these policies have been raised, such as whether the government truly needs to implement these policies using tax money, and whether it is acceptable to limit the personal freedoms of the physicians. In this paper, we discuss these issues from the perspectives of social justice, utilitarianism, luck egalitarianism, liberty, medical professionalism and consistency with national health insurance and the Japanese Constitution. We conclude that JMU/RQs are necessary and ethically valid policies, and also propose some institutional improvements to better secure the integrity and maturity of these systems.
Subject
Health Policy,Arts and Humanities (miscellaneous),Issues, ethics and legal aspects,Health (social science)
Reference51 articles.
1. World Health Organization . Increasing access to health workers in remote and rural areas through improved retention: global policy recommendations. 2010. Available: https://apps.who.int/iris/handle/10665/44369 [Accessed 02 Feb 2023].
2. Compulsory service programmes for recruiting health workers in remote and rural areas: do they work?
3. Matsumoto M , Inoue K , Kajii E , et al . Retention of physicians in rural Japan: concerted efforts of the government, prefectures, municipalities and medical schools. Rural Remote Health 2010;10:1432.
4. Japanese universal health coverage: evolution, achievements, and challenges
5. Matsumoto M . Ishi no Henzai (Maldistribution of physicians). In: Chiikiiryougaku nyuumon (Introduction to Community Health). Tokyo: Shindan To Chiryou Sha, 2019: 16–21.