Geographical Implications of the Psychiatric Clinic Location in the Metropolitan Areas in Japan

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  • 精神科診療所の立地における大都市集中の意味
  • セイシンカ シンリョウジョ ノ リッチ ニ オケル ダイトシ シュウチュウ ノ イミ

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So far, it is often pointed out that the emphasis upon equity is one of the characteristics in medical service provision in Japan. But when we look at the spatial aspect of the service provision, some geographical inequality can be observed due to the free entry system for the medical facilities. This paper attempts to find the locational patterns of the psychiatric clinics and to understand why the psychiatric clinics are concentrated in metropolitan areas in Japan. First, a brief sketch of the changing medical policy after the World War II in Japan has been outlined. In post-war Japan, construction of the private mental hospitals had been promoted bypolicy makers in order to protect the society from the mentally ill with lower public spending. As a result, many mental hospitals have been located in the outer fringe of the metropolitan areas. With the shift in medical policy towards deinstitutionalization and community care, increasing number of psychiatric clinics had been established, particularly near the railway stations. In the latter half of the 1980's, a series of the revision of medical treatment price made the psychiatric clinics profitable, and the many psychiatric clinics had burgeoned. The newly opened clinics had a tendency to locate their offices near the railway stations, as tenants in the commercial buildings, and within the commercial districts. Therefore, this has resulted in more uneven distribution of psychiatric care for the mentally ill. Beneath such locational pattern lies the doctors' tendency for easy access to attract more patients as well as the patients' preference of anonymous environment for receiving the care away from community prejudice to evade the mentally ill. It is concluded that mixed land use in commercial areas is playing important role in shaping the geography of psychiatric clinics in Japan, and the same effects of land use control can be recognized as the spatial concentration of the outpatients into the inner areas is caused by planning control in the US large cities.

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