Shiori Miyazawa

Towards the crisis of increasing elderly population in 2025, reforming the medical care system is an urgent issue. The purpose of this paper is to clarify Japan's regional differences in medical supply and demand in 2025 by focuses mainly on secondary medical areas. The data used for this analysis is taken from the "number of necessary beds in 2025" estimated by the prefecture governments in 2017 in the "Regional Health Vision". Regional differences are examined through categorizing the hospital beds per 100,000 population by quartiles among 341 secondary medical areas. As a result, regional disparities remain in the medical supply and demand even in 2025.

In recent years, public hospitals in Japan's rural areas, which are the main providers of medical care in rural areas, have been experiencing worsening financial conditions. In response, in 2007, the Ministry of Internal Affairs and Communications issued public hospital reform guidelines to local municipalities, requesting that they improve public hospital management as quickly as possible. Because the worsening fi nancial position of public hospitals is linked to their special organizational structure of strong ties with local governments, the guidelines urged making hospitals managerially independent from municipalities. However, in rural areas that would be especially strongly affected by the guidelines, the issue of medical care is an administrative issue of high public interest, and public hospitals and municipalities are linked inseparably. Consequently, whether the independence of public hospitals from municipalities as proposed by the guidelines is suitable for rural areas persists as an important research subject. <br/>This study, which was conducted to clarify management improvement measures for public hospitals in rural areas and benefi cial governance structures necessary to enable such measures, examined Oguni-Town in Yamagata Prefecture, which improved management of public hospitals without making them independent from municipalities. Measures adopted and implemented by the Oguni public hospital during 2008.2011, including the implementation of a change in the classification of hospital beds, promotion of medical examinations, and introduction of generic drugs, raised medical practice income and contributed to the improvement of management. These measures were developed through cooperation and the exchange of ideas among medical personnel of various specialties and local government officials. Such collaboration is a method that has been emphasized by Oguni-Town throughout its town planning activities. Through the use of common methods, administrative support for public hospital reform was obtained readily. Because the protection of medical care in rural areas is an important part of community building, it can be argued that maintaining a close relation between medical care providers and the community is important.

Many people living in rural areas must travel to distant urban areas for medical care. The problems that such low accessibility to hospitals bring to patients differ depending not only on patients’ conditions but also on their family structure. This study, using a medical behavior survey of residents of a mountain area who have constantly experienced problems of hospital access, examined how family support should be conducted for medical behavior. The region surveyed was a settlement in Oguni Town, Yamagata Prefecture. Members of all households in one settlement were interviewed, with inquiries about outpatient hospital visits and hospitalization of household members, and family support for medical related activities. Results revealed that many residents went to or were admitted to distant hospitals more than about 31 km distant from their homes, but that distance did not necessarily cause problems in their daily life. The reasons were the following: 1）For hospital visits, the frequency was low and travel was less burdensome. 2）For hospitalization, patients received more support from family members living separately near the hospitals than from family members living together.