The Impact of Pediatrician Supply on Child Health Outcomes: Longitudinal Evidence from Japan.
OBJECTIVE
To investigate the effect of pediatrician supply on under-5 mortality over the period 2000-2010.


METHODS
Multiple publicly available data sources were used.


METHODS
Japan'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.


RESULTS
Pediatrician 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.


CONCLUSIONS
The 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.
Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA.
Rie
R
Sakai
Department of Global Health and Population, Harvard School of Public Health, Boston, MA.
Günther
G
Fink
Department of Epidemiology, Harvard School of Public Health, Boston, MA.|Department of Healthcare Quality Assessment, The University of Tokyo, Tokyo, Japan.
Hiraku
H
Kumamaru
Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA.
Ichiro
I
Kawachi
D000067576:Child Health / Q000706:statistics & numerical data*; D046688:Child Mortality; D002675:Child, Preschool; D062305:Geographic Mapping; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D015233:Models, Statistical; D010372:Pediatrics; D000078329:Workforce
Human resources for health; Japan; pediatrician supply; under-5 mortality