Regional variation in national healthcare expenditure and health system performance in central cities and suburbs in Japan

The increasing national healthcare expenditure (NHE) with the aging rate
is a significant social problem in Japan, and efficient distribution and
use of NHE is an urgent issue. It is assumed that comparisons in
subregions would be important to explore the regional variation in NHE and
health system performance in targeted municipalities of the metropolitan
area of Tokyo (central cities) and the neighboring municipalities of Chiba
Prefecture (suburbs). This study aimed to clarify the differences of the
socioeconomic factors affecting NHE and the health system performances
between subregions. A multiple regression analysis was performed to
extract the factors affecting the total medical expenses of NHE (Total),
comprising the medical expenses of inpatients (MEI), medical expenses of
outpatients (MEO), and consultation rates of inpatients (CRI) and
outpatients (CRO). Using the stepwise method, dependent variables were
selected from three categories: health service, socioeconomic, and
lifestyle. Then, health system performance analysis was performed, and the
differences between regions were clarified using the Mann–Whitney U test.
The test was applied to 18 indicators, classified into five dimensions
referred to in the OECD indicators: health status, risk factors for
health, access to care, quality of care, and health system capacity and
resources. In the central cities, the number of persons per household was
the primary factor affecting Total, MEI, MEO, and CRO, and the number of
persons per household and the percentage of the entirely unemployed
persons primarily affected CRI. In the suburbs, the ratio of the
population aged 65–74 and the number of hospital beds were significantly
positively related to Total, MEI, and CRI, but the number of workers
employed in primary industries was negatively related to Total and MEI.
The ratio of the population aged 65–74 was significantly positively
related to MEO and CRO. Regarding health system performance, while risk
factors for health was high in the central cities, the others, including
access to care, quality of care, and health system capacity and resources,
were superior in the suburbs, suggesting that the health system might be
well developed to compensate for the risks. In the suburbs, while risk
factors for health were lower than those in the central cities, access to
care, quality of care, and health system capacity and resources were also
lower, suggesting that the healthcare system might be poorer. These
results indicate a need to prioritize mitigating healthcare disparities in
the central cities and promoting the health of the elderly in the suburbs
by expanding the suburbs’ healthcare systems and resources. This study
clarified that the determinants of NHE and health system performance are
drastically varied among subregional levels and suggested the importance
of precise regional moderation of the healthcare system.