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The Impact of Pediatrician Supply on Child Health Outcomes: Longitudinal Evidence from Japan
Author(s) -
Sakai Rie,
Fink Günther,
Kumamaru Hiraku,
Kawachi Ichiro
Publication year - 2016
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12354
Subject(s) - poisson regression , medicine , demography , child mortality , pediatrics , population , mortality rate , child health , longitudinal study , health care , environmental health , surgery , pathology , sociology , economics , economic growth
Objective To investigate the effect of pediatrician supply on under‐5 mortality over the period 2000–2010. Data Sources Multiple publicly available data sources were used. Study Design 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. Principal Findings 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.