Analyzing Disparity in Geographical Accessibility to Home Medical Care Using a Claims Database: A Simulation Using Geographical Information System
ABSTRACT
Background:
The demand for home medical care services has increased in aging societies. Therefore, allocating healthcare resources optimally to meet the needs of each community is essential. Geographical accessibility is an important factor affecting access to home medical care services; however, little research has been conducted on regional disparities in geographical accessibility.
Objective:
To analyze the regional disparities in geographic accessibility to home medical care services using the KDB, a comprehensive medical claims dataset for prefectures in Japan.
Methods:
We included 39 municipalities in Nara Prefecture, Japan. Using a geographical information system (GIS), accessibility to home medical care services, that is, travel distance and time from hospitals and clinics to hypothetical patients, was analyzed in two scenarios: (1) an ideal scenario, where we assumed that all hospitals or clinics in Nara Prefecture that provided those services were used; and (2) an actual scenario, where hospitals or clinics in Nara Prefecture that actually provided home medical care services, identified from KDB data analysis, were used in the analysis. Hypothetical patients were randomly distributed on the GIS in accordance with the utilization rates of home medical care services and with the distributions of the population aged ≥ 75 years. The utilization rate by municipalities and hospitals or clinics providing these services were identified from the analysis of KDB data of Nara Prefecture in FY2019.
Results:
The median travel distance was longer than 16 km, the reference value specified in the Japanese fee table, and the median travel time exceeded 30 min in certain rural municipalities in the southern part of Nara Prefecture, such as Kawakami and Totsukawa, in the actual scenario, whereas the distance was less than 10 km and the time was mostly shorter than 15 min in the ideal scenario. The utilization rates were also lower in rural municipalities in the southern part.
Conclusions:
The results revealed that geographical accessibility was lower in depopulated municipalities in the southern part, and the disparity could be partly solved in the ideal scenario. KDB is a comprehensive dataset that includes medical claims information for home medical care patients and details of the provision of medical institutions, enabling geographical analysis that reflects actual healthcare utilization. Clinical Trial: Not applicable
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