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Beyond urban bias: A circulation-based model for equitable medical workforce distribution.
Atsushi Jinno1,2, Yoshihisa Tsuji1,2
1Department of General Medicine, Shiga University of Medical Science, Otsu City, Shiga, Japan.
Dialogues in Health
|July 6, 2026
Summary
A new circulation-based model improved healthcare in rural Japan by coordinating physician rotations and digital health, leading to better health, financial, and educational outcomes.
Area of Science:
- Healthcare management
- Public health
- Medical education
Background:
- Urban-rural healthcare disparities are a global issue due to uneven medical resource distribution.
- A circulation-based model integrating resource allocation, education, and digital health was developed to address these disparities.
Purpose of the Study:
- To examine the structure and outcomes of a circulation-based healthcare model implemented in Hokkaido, Japan since 2020.
- To assess the impact of the model on health, financial, and educational outcomes in a rural Japanese setting.
Main Methods:
- The model incorporated physician and trainee rotation, structured referral pathways, community-based medical education, and digital infrastructure.
- A three-tier system was established: Esashi (primary/secondary), Hakodate (tertiary), and Sapporo (education/dispatch hub).
Main Results:
- Standardized mortality ratio decreased for males (103.4 to 98.3) and females (104.8 to 100.5), with a significant decrease in pneumonia-related SMR.
- Financial indicators improved, evidenced by a significant increase in inpatient revenue per patient (26,553 to 38,478 JPY).
- Medical students reported enhanced confidence in clinical competencies.
Conclusions:
- The developed model effectively improved health, financial, and educational outcomes.
- Coordination of physician mobility, tiered regional collaboration, and digital connectivity were key to the model's success.
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