Abstract

Non-physician community' (NPC) is a policy term that indicates a medically underserved area in Japan. Designated NPCs are politically targeted as the foci of medical resource allocation. NPC is defined as a specified district where 50 or more persons dwell within a geographic diameter of 4 km and medical care is not easily accessible. The definition of NPC was first introduced in 1960 and has been unchanged for more than half a century despite radical social changes in rural Japan. This study examines whether designated NPCs are still more disadvantaged in terms of geographical access to healthcare in comparison to other communities. Hiroshima prefecture, which has the largest number of NPCs in terms of tertiary healthcare areas of Japan, was used as the study area. Targeted communities were all the NPCs in the prefecture, and, as controls, two community groups were selected: non-NPC adjacent to NPC, and municipal center. We measured driving time from NPCs and control communities to the nearest healthcare facilities, which were classified into the following two types: primary or secondary care facilities (n=2636) and tertiary care facilities (equal to tertiary emergency care centers; n=6). We further calculated the driving time to the nearest facilities for secondary emergency care (n=246) extracted from the 2636 primary or secondary care facilities. The median driving times to the nearest primary or secondary healthcare facility for NPC, non-NPC, and municipal center were 11 minutes, 11 minutes, and 1 minute, respectively; the times to a tertiary healthcare facility (equal to an accident and emergency care center) were 80 minutes, 84 minutes, and 68 minutes, respectively; and the times to a secondary emergency care facility were 24 minutes, 18 minutes, and 15 minutes, respectively. Although a municipal center was significantly more advantageous in driving time compared to a primary or secondary care facility, the disadvantage of a NPC in access was no more obvious than an adjacent non-NPC for any type of healthcare facility. NPCs had a disadvantage in access time to primary, secondary and tertiary medical care compared with a municipal center. NPCs, however, did not have a greater access disadvantage in comparison to adjacent rural communities for any type of medical facility. As such, future resource allocation policies in Japan need to redefine medically underserved communities.

Highlights

  • Geographic maldistribution of health resources is an old and worldwide issue

  • The key concept and term used in this policy is ‘non-physician community’ (NPC; mui-chiku in Japanese), which is used for demarcating medically underserved areas that need a more focused allocation of health resources

  • We selected Hiroshima prefecture, which had the largest number of designated NPCs among the 45 prefectures of Japan with a single tertiary healthcare area6

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Summary

Introduction

Geographic maldistribution of health resources is an old and worldwide issue. In Japan, the first resource allocation policy for medically underserved areas was introduced in 1957 and has been revised 11 times. The key concept and term used in this policy is ‘non-physician community’ (NPC; mui-chiku in Japanese), which is used for demarcating medically underserved areas that need a more focused allocation of health resources. The concept of NPC was first employed in the revision of this policy in 1960 and has remained unchanged until now. It has been used as the only officially defined political term that indicates medically underserved areas. The national definitions of NPC and semi-NPC are as follows:

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