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Geographic distribution of healthcare resources, healthcare service provision, and patient flow in Japan: A cross sectional study


  • Shinjo, Daisuke
  • Aramaki, Toshiharu


Healthcare systems in developed countries are facing the challenge of dealing with changing social structures as a result of rapidly aging populations. This study examines the relationship among the geographical distribution of healthcare resources, healthcare service provision, and interregional patient flow in Japan. A cross-sectional study was performed using data from healthcare-related public surveys conducted in 2008, together with social, economic, and environmental variables. The geographical units of analysis were 348 Secondary Healthcare Service Areas, which provide and manage most healthcare services in Japan. The equity of the distribution of physicians among hospitals and clinics was evaluated using the Lorenz curve and the Gini coefficient. Multiple regression analysis was used to examine the relationships between the inpatient flow ratio and selected variables. Next, the 348 Secondary Healthcare Service Areas were divided into tertiles according to the inpatient flow ratio, and differences among these variables were examined using Bonferroni's correction for multiple comparisons. The Gini coefficient for physician distribution among hospitals was 0.209 and was 0.165 among clinics. Multiple regression analysis showed that hospital physician density, the elderly ratio, and hospital bed density were all correlated with the inpatient flow ratio (β = 0.396, −0.576, 0.425, respectively; R2 = 0.622, all ps < 0.001). Healthcare resources were significantly more scarce in the lowest tertile (outflow group) than in other groups in both hospitals and clinics. The provision of healthcare services was also imbalanced among tertiles. Our results imply that there is a need for reconstituting the geographical distribution of healthcare resources in Japan. Further research and healthcare-related databases are also needed to facilitate the creation of a more balanced geographical distribution and of a more effective healthcare system in Japan.

Suggested Citation

  • Shinjo, Daisuke & Aramaki, Toshiharu, 2012. "Geographic distribution of healthcare resources, healthcare service provision, and patient flow in Japan: A cross sectional study," Social Science & Medicine, Elsevier, vol. 75(11), pages 1954-1963.
  • Handle: RePEc:eee:socmed:v:75:y:2012:i:11:p:1954-1963
    DOI: 10.1016/j.socscimed.2012.07.032

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    References listed on IDEAS

    1. Daniele Fabbri & Silvana Robone, 2010. "The geography of hospital admission in a national health service with patient choice," Health Economics, John Wiley & Sons, Ltd., vol. 19(9), pages 1029-1047, September.
    2. Philip SEATON, 2010. "Depopulation and Financial Collapse in Yūbari: Market Forces, Administrative Folly, or a Warning to Others?," Social Science Japan Journal, Oxford University Press, vol. 13(2), pages 227-240.
    3. Lovett, Andrew & Haynes, Robin & Sünnenberg, Gisela & Gale, Susan, 2002. "Car travel time and accessibility by bus to general practitioner services: a study using patient registers and GIS," Social Science & Medicine, Elsevier, vol. 55(1), pages 97-111, July.
    4. Kagamimori, Sadanobu & Gaina, Alexandru & Nasermoaddeli, Ali, 2009. "Socioeconomic status and health in the Japanese population," Social Science & Medicine, Elsevier, vol. 68(12), pages 2152-2160, June.
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    2. Qin, Xuezheng & Hsieh, Chee-Ruey, 2014. "Economic growth and the geographic maldistribution of health care resources: Evidence from China, 1949-2010," China Economic Review, Elsevier, vol. 31(C), pages 228-246.
    3. Sepideh Abolghasem & Mehdi Toloo & Santiago Amézquita, 2019. "Cross-efficiency evaluation in the presence of flexible measures with an application to healthcare systems," Health Care Management Science, Springer, vol. 22(3), pages 512-533, September.
    4. Masayoshi Hayashi & Akiko Oyama, "undated". "Factor decomposition of inter-prefectural health care expenditure disparities in Japan," Discussion papers ron264, Policy Research Institute, Ministry of Finance Japan.
    5. Liu, Hu-Chen, 2013. "A theoretical framework for holistic hospital management in the Japanese healthcare context," Health Policy, Elsevier, vol. 113(1), pages 160-169.
    6. S. Balia & R. Brau & E. Marrocu, 2014. "Free patient mobility is not a free lunch. Lessons from a decentralised NHS," Working Paper CRENoS 201409, Centre for North South Economic Research, University of Cagliari and Sassari, Sardinia.
    7. Emanuela Marrocu & Silvia Balia & Rinaldo Brau, 2016. "A spatial analysis of inter-regional patient mobility in Italy," ERSA conference papers ersa16p127, European Regional Science Association.
    8. Xing, Zhang & Oyama, Tatsuo, 2016. "Measuring the impact of Japanese local public hospital reform on national medical expenditure via panel data regression," Technological Forecasting and Social Change, Elsevier, vol. 113(PB), pages 460-467.

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