Seo Yuna, Takikawa Takaharu
Department of Industrial Administration, Faculty of Science and Technology, Tokyo University of Science, Noda 278-8510, Japan.
Healthcare (Basel). 2022 May 24;10(6):968. doi: 10.3390/healthcare10060968.
The increasing national healthcare expenditure (NHE) with the aging rate is a significant social problem in Japan, and efficient distribution and use of NHE is an urgent issue. It is assumed that comparisons in subregions would be important to explore the regional variation in NHE and health system performance in targeted municipalities of the metropolitan area of Tokyo (central cities) and the neighboring municipalities of Chiba Prefecture (suburbs). This study aimed to clarify the differences of the socioeconomic factors affecting NHE and the health system performances between subregions. A multiple regression analysis was performed to extract the factors affecting the total medical expenses of NHE (Total), comprising the medical expenses of inpatients (MEI), medical expenses of outpatients (MEO), and consultation rates of inpatients (CRI) and outpatients (CRO). Using the stepwise method, dependent variables were selected from three categories: health service, socioeconomic, and lifestyle. Then, health system performance analysis was performed, and the differences between regions were clarified using the Mann-Whitney test. The test was applied to 18 indicators, classified into five dimensions referred to in the OECD indicators: health status, risk factors for health, access to care, quality of care, and health system capacity and resources. In the central cities, the number of persons per household was the primary factor affecting Total, MEI, MEO, and CRO, and the number of persons per household and the percentage of the entirely unemployed persons primarily affected CRI. In the suburbs, the ratio of the population aged 65-74 and the number of hospital beds were significantly positively related to Total, MEI, and CRI, but the number of workers employed in primary industries was negatively related to Total and MEI. The ratio of the population aged 65-74 was significantly positively related to MEO and CRO. Regarding health system performance, while risk factors for health was high in the central cities, the others, including access to care, quality of care, and health system capacity and resources, were superior in the suburbs, suggesting that the health system might be well developed to compensate for the risks. In the suburbs, while risk factors for health were lower than those in the central cities, access to care, quality of care, and health system capacity and resources were also lower, suggesting that the healthcare system might be poorer. These results indicate a need to prioritize mitigating healthcare disparities in the central cities and promoting the health of the elderly in the suburbs by expanding the suburbs' healthcare systems and resources. This study clarified that the determinants of NHE and health system performance are drastically varied among subregional levels and suggested the importance of precise regional moderation of the healthcare system.
随着老龄化率上升，日本国家医疗保健支出（NHE）不断增加，这是一个重大的社会问题，高效分配和使用NHE是一个紧迫问题。据推测，在东京都市区（中心城市）的目标市和千叶县相邻市（郊区）进行次区域比较，对于探究NHE的区域差异和卫生系统绩效很重要。本研究旨在阐明影响NHE的社会经济因素以及次区域之间卫生系统绩效的差异。进行了多元回归分析，以提取影响NHE总医疗费用（Total）的因素，Total包括住院患者医疗费用（MEI）、门诊患者医疗费用（MEO）、住院患者会诊率（CRI）和门诊患者会诊率（CRO）。使用逐步法，从健康服务、社会经济和生活方式三个类别中选择因变量。然后，进行卫生系统绩效分析，并使用曼-惠特尼检验阐明区域之间的差异。该检验应用于18项指标，这些指标分为经合组织指标中提到的五个维度：健康状况、健康风险因素、获得医疗服务、医疗质量以及卫生系统能力和资源。在中心城市，每户人数是影响Total、MEI、MEO和CRO的主要因素，每户人数和完全失业人员百分比主要影响CRI。在郊区，65 - 74岁人口比例和医院床位数与Total、MEI和CRI显著正相关，但第一产业就业人数与Total和MEI负相关。65 - 74岁人口比例与MEO和CRO显著正相关。关于卫生系统绩效，虽然中心城市的健康风险因素较高，但包括获得医疗服务、医疗质量以及卫生系统能力和资源在内的其他方面在郊区更优，这表明卫生系统可能发展良好以弥补风险。在郊区，虽然健康风险因素低于中心城市，但获得医疗服务、医疗质量以及卫生系统能力和资源也较低，这表明医疗保健系统可能较差。这些结果表明，需要优先缓解中心城市的医疗保健差距，并通过扩大郊区的医疗保健系统和资源来促进郊区老年人的健康。本研究阐明，NHE和卫生系统绩效的决定因素在次区域层面差异很大，并表明了精确的区域医疗保健系统调控的重要性。
