ObjectivesThe objective of this study was to longitudinally examine the geographic distribution of physicians in Japan with adjustment for healthcare demand according to changes in population age structure.MethodsWe examined trends in the number of physicians per 100 000 population in Japan's secondary medical areas (SMAs) from 2000 to 2014. Healthcare demand was adjusted using health expenditure per capita. Trends in the Gini coefficient and the number of SMAs with a low physician supply were analysed. A subgroup analysis was also conducted where SMAs were divided into 4 groups according to urban–rural classification and initial physician supply.ResultsThe time-based changes in the Gini coefficient and the number of SMAs with a low physician supply indicated that the equity in physician distribution had worsened throughout the study period. The number of physicians per 100 000 population had seemingly increased in all groups, with increases of 22.9% and 34.5% in urban groups with higher and lower initial physician supply, respectively. However, after adjusting healthcare demand, physician supply decreased by 1.3% in the former group and increased by 3.5% in the latter group. Decreases were also observed in the rural groups, where the number of physicians decreased by 4.4% in the group with a higher initial physician supply and 7.6% in the group with a lower initial physician supply.ConclusionsAlthough the total number of physicians increased in Japan, demand-adjusted physician supply decreased in recent years in all areas except for urban areas with a lower initial physician supply. In addition, the equity of physician distribution had consistently deteriorated since 2000. The results indicate that failing to adjust healthcare demand will produce misleading results, and that there is a need for major reform of Japan's healthcare system to improve physician distribution.

To investigate the associations between dementia, the use of long-term care (LTC) services, and the deterioration of care-needs levels of elderly persons in Japan.Using a retrospective cohort study, we analyzed 50,268 insurance beneficiaries aged 65 years and older who had utilized LTC services between 2010 and 2011 in Kyoto prefecture, Japan. Logistic regression analyses were used to identify predictors of care-needs level deterioration.Dementia, facility care services, the male sex, older age, and lower baseline care-needs levels were associated with care-needs level deterioration. The disparity between odds ratios of home care services, dementia diagnoses, and facility care services on care-needs level deterioration diminished with increasing baseline care-needs levels. The other risk factors of care-needs level deterioration showed stronger associations as care-needs levels and age increased.The effects of baseline care-needs levels and dementia should be considered when developing LTC policies.

Indicators of both aggressive and palliative EOL care were associated with higher healthcare expenditures. These results may support the coherent development of measures to optimize aggressive care and reduce the financial burdens of terminal cancer care.

After designing a costing framework, a nationwide database comprised of individual case-level costs with components for acute-care hospitals in Japan was successfully developed. We hope this study contributes to appropriate decision making and helps motivate further research geared towards efficient hospital management and a rational payment system in Japan.

BackgroundJapan is known for its long life expectancy and rapidly aging society that there are various demands of older adults need to be fulfilled with, and one of them is long-term care needs. Therefore, Japan implemented the Long-Term Care Insurance in year 2000 for citizens who are above 65-year old and citizens who are above 40-year old in needs of long-term care services. This study was undertaken to longitudinally examine the influence of dementia and living alone on care needs increases among older long-term care insurance service users in Japan.MethodsLong-term care insurance claims data were used to identify enrollees who applied for long-term care services between October 2010 and September 2011, and subjects were tracked until March 2015. A Kaplan-Meier survival analysis was conducted to examine increases in care needs over time in months. Cox regression models were used to examine the effects of dementia and living alone on care needs increases.ResultsThe cumulative survival rates before care needs increased over the 4.5-year observation period were 17.6% in the dementia group and 31.9% in the non-dementia group. After adjusting for age, sex, care needs level, and status of living alone, the risk of care needs increases was found to be 1.5 times higher in the dementia group. Living alone was not a significant risk factor of care needs increases, but people with dementia who lived alone had a higher risk of care needs increases than those without dementia.ConclusionDementia, older age, the female sex, and lower care needs levels were associated with a higher risk of care needs increases over the study period. Among these variables, dementia had the strongest impact on care needs increases, especially in persons who lived alone.