Analyzing the causes of the uneven geographical distribution of per-capita medical care expenditures for elderly persons aged 75 years or older between western and eastern Japanese prefectures

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  • Kinoshita Naohiko
    Department of Health Informatics, Niigata University of Health and Welfare Graduate School of Health and Welfare, Niigata University of Health and Welfare
  • Hada Ryona
    Department of Health Informatics, Niigata University of Health and Welfare
  • Watanabe Senka
    Department of Health Informatics, Niigata University of Health and Welfare
  • Suzuki Akie
    Department of Health Informatics, Niigata University of Health and Welfare
  • Tajiri Masayuki
    Department of Health Informatics, Niigata University of Health and Welfare
  • Yamagishi Mina
    Department of Health Informatics, Niigata University of Health and Welfare
  • Kanno Suzuka
    Department of Health Informatics, Niigata University of Health and Welfare
  • Itagaki Takumi
    Department of Health Informatics, Niigata University of Health and Welfare
  • Namizuka Asuka
    Graduate School of Health and Welfare, Niigata University of Health and Welfare
  • Awashima Masahiro
    Department of Health Informatics, Niigata University of Health and Welfare
  • Kobayashi Fusayo
    Graduate School of Health and Welfare, Niigata University of Health and Welfare
  • Watarai Yuko
    Graduate School of Health and Welfare, Niigata University of Health and Welfare
  • Takigchi Toru
    Department of Health Informatics, Niigata University of Health and Welfare Graduate School of Health and Welfare, Niigata University of Health and Welfare

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<p>The per-capita medical expenditures of elderly persons aged 75 years and older (hereafter, ME75) in each prefecture of western Japan and the Hokkaido area are higher than those in each of the eastern prefectures. This geographical uneven Distribution among ME75 in Japan can thus be summarized as follows: Per-capita medical expenditures among ME75 in Japan are higher in western areas than eastern areas (hereafter, WJhigh_EJlow). However, this uneven distribution has only been visually identified using a quartile map of ME75 without statistics. Further, current statistical verifications of the causes (e.g., supply and demand for medical care) are insufficient. As such, this study statistically confirmed uneven distribution among ME75 in different areas of Japan and identified the causes. Here, several specific analyses were conducted, including Fisher's exact test (hereafter, FET), bivariate Moran's I (hereafter, bi_MoI), and a quantitative analysis via multivariate regional clustering (hereafter, multi_RC) to adjust for confounding factors. All such analyses were performed using Bellcurve for Excel 3.20. Finally, a spacial_Multiple Regression Analysis (hereafter, spacial_MRA) of the GeoDa system was conducted to confirm uneven distribution, Results clearly showed a distribution of ME75 among all 47 Japanese prefectures following WJhigh_EJlow typed through multi_RC. Further, the population ratio of long-term care beds and general beds were identified as the main contributing economic medical factors via multi_RC with ME75 by spacial_MRA. The high ME75 in western Japan can be considered supporting evidence that elderly persons have high access to hospitals as required by the community-based integrated care system. On the other hand, low ME75 in eastern Japan will be evaluated because it will be considered to yield the collapse of the Japan's medical care system due to rapid rising of medical care expenditures. Therefore, further comparative studies will be necessary to determine whether the West Japan system is superior or the East Japan system is superior.</p>

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