Kobayashi Daisuke, Otsubo Tetsuya, Imanaka Yuichi
Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
Health Policy. 2015 Mar;119(3):298-306. doi: 10.1016/j.healthpol.2014.11.008. Epub 2014 Nov 20.
To analyze the regional variations in travel time between patient residences and medical facilities for the treatment of ischemic heart disease and breast cancer, and to simulate the effects of health care services centralization on travel time and equality of access.
We used medical insurance claims data for inpatients and outpatients for the two target diseases that had been filed between September 2008 and May 2009 in Kyoto Prefecture, Japan. Using a geographical information system, patient travel times were calculated based on the driving distance between patient residences and hospitals via highways and toll roads. Locations of residences and hospital locations were identified using postal codes. We then conducted a simulation analysis of centralization of health care services to designated regional core hospitals. The simulated changes in potential spatial access to care were examined.
Inequalities in access to care were examined using Gini coefficients, which ranged from 0.4109 to 0.4574. Simulations of health care services centralization showed reduced travel time for most patients and overall improvements in equality of access, except in breast cancer outpatients.
Our findings may contribute to the decision-making process in policies aimed at improving the potential spatial access to health care services.
分析缺血性心脏病和乳腺癌患者住所与医疗机构之间就医时间的区域差异，并模拟医疗服务集中化对就医时间和就医公平性的影响。
我们使用了2008年9月至2009年5月期间日本京都府针对这两种目标疾病的住院和门诊医疗保险理赔数据。利用地理信息系统，根据患者住所与医院之间通过高速公路和收费公路的驾车距离计算患者就医时间。使用邮政编码确定住所位置和医院位置。然后，我们对医疗服务集中到指定区域核心医院进行了模拟分析。研究了潜在空间就医机会的模拟变化。
使用基尼系数检验了就医机会的不平等，范围在0.4109至0.4574之间。医疗服务集中化模拟显示，除乳腺癌门诊患者外，大多数患者的就医时间减少，就医公平性总体改善。
我们的研究结果可能有助于旨在改善潜在空间医疗服务可及性的政策决策过程。
