Wakabayashi K, Nakamura K, Masaki M, Yamamoto W, Denda K, Nakamura Y, Yanagawa H
Department of Public Health, National Defense Medical College, Saitama, Japan.
Nihon Eiseigaku Zasshi. 1995 Oct;50(4):839-48. doi: 10.1265/jjh.50.839.
To obtain basic data concerning the availability of medical care for intractable diseases in a large city and its environs, we analyzed the data of Saitama Prefecture. These data were selected from a nationwide survey conducted by the Epidemiology of Intractable Diseases Research Committee of the Ministry of Health and Welfare in Japan. The characteristics of medical institutions visited by patients with 26 intractable diseases were analyzed. The patients were receiving financial aid for treatment. The subjects were 4234 patients in 1984 and 6804 patients in 1988. In addition, we compared the data of 1984 with those of 1988. The results are as follows: 1) In both years, the characteristics of medical institutions which were visited varied in terms of the individual disease. The proportion of patients who visited medical institutions in the same medical service area and in the same prefecture were both very low. The percentage of patients who visited medical institutions in Tokyo was more than 30% of the total, and was more than 50% for the disease with the highest proportion of patients. The dependency on Tokyo for medical institutions was inversely proportional to the distance from Tokyo. Most patients were highly dependent on a large hospital, but the proportion of patients with SMON and ulcerative colitis who visited a large hospital was markedly lower than that for other diseases. 2) A comparison of the data of 1984 with those of 1988 showed that in most of medical service areas, the proportion of patients who visited medical institutions in the same medical service area and in Saitama Prefecture increased, but in Tokyo Prefecture the proportion decreased. We continuously observed a high dependency on a university hospital located about 60km distance from downtown Tokyo, but the dependency slightly decreased in 1988. When a new branch of a university hospital opened, many intractable disease patients then depended on that branch. These results suggest that the self-sufficiency levels of medical services for intractable diseases gradually rose in Saitama Prefecture. The illness behavior of intractable disease patients in Saitama Prefecture did not show any remarkable changes, therefore those results in Saitama Prefecture might indicate a universal characteristic of medical institutions visited by intractable disease patients who live in the envirous of a large city (Tokyo).
为获取有关大城市及其周边地区难治性疾病医疗服务可及性的基础数据，我们分析了埼玉县的数据。这些数据选自日本厚生省难治性疾病流行病学研究委员会开展的一项全国性调查。分析了26种难治性疾病患者就诊的医疗机构的特点。这些患者接受治疗的经济援助。研究对象为1984年的4234名患者和1988年的6804名患者。此外，我们将1984年的数据与1988年的数据进行了比较。结果如下：1）在这两年中，患者就诊的医疗机构特点因疾病个体而异。在同一医疗服务区和同一县内就诊的患者比例都非常低。在东京就诊的患者比例超过总数的30%，对于患者比例最高的疾病，这一比例超过50%。对东京医疗机构的依赖程度与距东京的距离成反比。大多数患者高度依赖大型医院，但患亚急性脊髓视神经病（SMON）和溃疡性结肠炎的患者就诊大型医院的比例明显低于其他疾病。2）1984年与1988年的数据比较表明，在大多数医疗服务区，在同一医疗服务区和埼玉县内就诊的患者比例有所增加，但在东京都内这一比例下降。我们持续观察到对距离东京市中心约60公里的一所大学医院的高度依赖，但在1988年这种依赖略有下降。当一所大学医院开设新分院时，许多难治性疾病患者随后便依赖该分院。这些结果表明，埼玉县难治性疾病医疗服务的自给自足水平逐渐提高。埼玉县难治性疾病患者的患病行为未显示出任何显著变化，因此埼玉县的这些结果可能表明了居住在大城市（东京）周边的难治性疾病患者就诊医疗机构的普遍特征。
