Ohashi Kazuki, Abe Arisa, Fujiwara Kensuke, Nishimoto Naoki, Ogasawara Katsuhiko
Faculty of Health Sciences, Hokkaido University, Kita-Ku, Sapporo, Japan.
Department of Health Sciences, School of Medicine, Hokkaido University, Kita-Ku, Sapporo, Japan.
J Family Med Prim Care. 2023 Apr;12(4):734-742. doi: 10.4103/jfmpc.jfmpc_2077_22. Epub 2023 Apr 17.
The Japanese government has promoted policies ensuring standardized medical care across the secondary medical care areas (SMCAs); however, these efforts have not been evaluated, making the current conditions unclear. Multidimensional indicators could identify these differences; thus, this study examined the regional characteristics of the medical care provision system for 21 SMCAs in Hokkaido, Japan, and the changes from 1998 to 2018.
This study evaluated the characteristics of SMCAs by principal component analysis using multidimensional data related to the medical care provision system. Factor loadings and principal component scores were calculated, with the characteristics of each SMCA visually expressed using scatter plots. Additionally, data from 1998 to 2018 were analyzed to clarify the changes in SMCAs' characteristics.
The primary and secondary principal components were and , respectively. The components included the number of hospitals, clinics, and doctors, and an area's population of older adults, accounting for 65.28% of the total variance. The components included the number of districts without doctors and the population and a land area of these districts, accounting for 23.20% of the variance. The accumulated proportion of variance was 88.47%. From 1998 to 2018, the area with the highest increase in was Sapporo, with numerous initial medical resources (-9.283 to -10.919).
Principal component analysis summarized multidimensional indicators and evaluated SMCAs in this regional assessment. This study categorized SMCAs into four quadrants based on and . Additionally, the difference in principal component scores between 1998 and 2018 emphasized the expanding gap in the medical care provision system among the 21 SMCAs.
日本政府推行了确保二级医疗保健区域（SMCAs）医疗服务标准化的政策；然而，这些努力尚未得到评估，目前情况不明。多维指标可以识别这些差异；因此，本研究考察了日本北海道21个二级医疗保健区域医疗服务提供系统的区域特征以及1998年至2018年的变化。
本研究使用与医疗服务提供系统相关的多维数据，通过主成分分析评估二级医疗保健区域的特征。计算因子载荷和主成分得分，并用散点图直观地表示每个二级医疗保健区域的特征。此外，分析1998年至2018年的数据，以阐明二级医疗保健区域特征的变化。
第一主成分和第二主成分分别为 和 。第一主成分包括医院、诊所和医生的数量，以及该地区的老年人口，占总方差的65.28%。第二主成分包括无医生地区的数量、这些地区的人口和土地面积，占方差的23.20%。方差累积比例为88.47%。从1998年到2018年，第一主成分增幅最大的地区是札幌，其初始医疗资源众多（-9.283至-10.919）。
主成分分析总结了多维指标，并在本次区域评估中对二级医疗保健区域进行了评估。本研究根据第一主成分和第二主成分将二级医疗保健区域分为四个象限。此外，1998年至2018年主成分得分的差异突出了21个二级医疗保健区域在医疗服务提供系统方面不断扩大的差距。
