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This study aims to analyze associations between lifestyle-related factors and body mass index (BMI) and blood pressure (BP) in middle-aged and older people in Japan. An association analysis using a multilevel model with demographic and lifestyle-related factors as variables and with BMI, systolic blood pressure (SBP), and diastolic blood pressure (DBP) as outcomes was conducted. Among the modifiable lifestyle factors, we found a significant dose-response association for BMI and slower eating (fast: reference; normal: −0.123 kg/m2 and slow: −0.256 kg/m2). Consuming >60 g/d ethanol was significantly associated, before and after adjustment for BMI, with an increase in SBP of 3.109 and 2.893 mm Hg, respectively. These findings suggest that health guidance should focus on factors such as the eating rate and drinking habits.

Japan's initial response to COVID-19 was similar to that of the US. However, the number of deaths in Japan has remained very low. Japan also stands out for the relatively low incidence of viral transmission in Long-Term Care Facilities (LTCFs) compared to both European countries and the United States. We argue that Japan's institutional decision to lockdown Long-Term Care facilities as early as mid-February - weeks earlier than most European countries and the US - contributed to lowering the number of deaths in LTCFs. We highlight a few lessons from the Japanese experience: (i) the presence of hierarchically organized government agencies whose sole missions are elderly care; (ii) the presence of effective communication channels between LTCFs and the regulatory authorities; and (iii) the well-established routine protocols of prevention and control in LTCFs.

Many countries face major challenges to ensure that their health and social care systems are ready for the growing numbers of older people (OP). As a way of realising ageing in place, assistive technologies such as home-care robots are expected to play a greater role in the future. In Asia and Europe, robots are gradually being adopted as a public policy solution to the workforce shortage. Yet, there is still a strongly held belief that such technologies should not be part of human and personal care services such as OP's care. However, there has been little research into attitudes and perceptions of potential users regarding home-care robots which can provide companionship and support with activities of daily living. To explore these in more detail, a questionnaire study was carried out in Finland, Ireland and Japan. This study reports findings from the Irish cohort (114 older people [OP], 8 family carers and 56 Health and Social Care Professionals [HSCPs]). Seventy per cent of the total respondents (N = 178) reported being open to the use of home-care robots, and only one quarter had a negative image of robots. People with care responsibilities in their private capacity expressed more interest in, and readiness to use, home-care robots, while stressing the importance of 'privacy protection' and 'guaranteed access to human care'. Both OP and HSCPs identified observation and recording of OP's mental and physical condition as desirable functions of such robots, whereas practical functions such as fall prevention and mobility support were also deemed desirable by HSCPs. There is generally positive interest in home-care robots among Irish respondents. Findings strongly suggest that the interest is generated partly by great need among people who deliver care. Should such robots be developed, then careful consideration must be given to user-centred design, ethical aspects and national care policy.

Objective We tested the construct validity and responsiveness of a single-item instrument for measuring absolute presenteeism-the single-item presenteeism question (SPQ). Methods Two self-report questionnaire surveys were conducted among employees of 24 small- or medium-sized companies (N = 1021) concerning the recognized predictors of presenteeism-absenteeism, subjective health risks, work engagement, and workplace social capital. Responsiveness was measured by determining whether changes in the presence of predictors between the surveys were accompanied by commensurate changes in SPQ presenteeism. Results SPQ presenteeism exhibited significant associations with the predictors, denoting adequate construct validity. Regarding responsiveness, unfavorable changes in most predictors were associated with increased SPQ presenteeism, as expected. Conclusions We confirmed the construct validity and responsiveness of the SPQ-an instrument that can be employed to promote workplace health and productivity management.

Purpose This study aims to compare the level of needs for home-care robots amongst older adults, family caregivers and home-care staff and clarify the factors constituting these needs. Design/methodology/approach A cross-sectional, anonymous questionnaire survey was administered. It included 52 items related to needs for home-care robots rated on a four-point Likert scale. Means and standard deviations were calculated, and the Kruskal-Wallis test was performed for each item. Factor analysis was conducted on the needs of home-care staff. Findings Responses from 79 older adults, 54 family caregivers and 427 home-care staff were analysed. For all three groups, the level of agreement was high for the following needs: to inform family and support personnel immediately when older adults fall, about their location in case of natural disasters and about mismanagement of fire by older adults with dementia. For family caregivers and home-care staff, the level of need concerning monitoring was higher than for older adults. Extracted using factor analysis, the six factors representing the essential needs for home-care robots were risk minimisation, daily monitoring of the physical condition, supporting activities of daily living (ADL) and instrumental ADL, pre-empting problems, communication and miscellaneous support. Originality/value The results showed that the education of caregivers and the co-design process of robot development should involve home-care staff, older adults and family caregivers, which are important for making decisions about the use of home-care robots for older adults.

Because of the workforce shortage in Japan, the use of home-care robots, or carebots, is increasingly perceived as a realistic option. Developing and implementing these carebots requires careful co...

This study, conducted at major Japanese companies, aimed to determine if asymptomatic workers in workplaces with a high prevalence of metabolic syndrome have a greater risk of developing metabolic syndrome. Data were obtained from the health records of 298,145 people, from 2011 to 2015. We collected data on the participants' age, sex, physical examinations, laboratory tests, and lifestyle behaviors. To test whether the risk of metabolic syndrome in asymptomatic workers differed between groups with a higher and lower prevalence in 2011, Cox proportional hazards regression model was performed, with the covariates being controlled for. The analysis showed that the risk of metabolic syndrome among asymptomatic workers in the high-prevalence group was about 1.1-fold elevated compared to those within the low-prevalence group. As a follow-up to these results, interventions aimed at asymptomatic workers should be provided in workplaces with a high prevalence of metabolic syndrome.

Background The health conditions of Japanese salespersons may be adversely affected by their lifestyle. Face-to-face or on-site health interventions are not convenient for salespersons because of their tendency for out-of-office sales. Previous studies showed that mobile health (mHealth) interventions (compared to usual practice) have great potential to promote physical activity. For Japanese salespersons, mHealth can offer additional convenience to change their physical activity habits because they can access the mHealth contents anytime and anywhere. However, the specific elements that are most important to maintain physical activity levels using an mHealth approach remain unclear. Objective We aimed to identify elements that account for both a high average physical activity level and can help to prevent a decrease in physical activity during a 9-week intervention period. Methods Salespersons were recruited from 11 Japanese companies. A team-based walking intervention was held from October to December 2018 (for a total of 9 weeks), during which the walking step data were recorded by smartphone apps. Average walking steps of each participant during the intervention and the difference in walking steps between the initial and the final week were respectively used as dependent variables. The effects of team characteristics (ie, frequency of communication with team members and team size) and behavioral characteristics (ie, number of days with recorded steps on the apps) on the average walking steps, and the difference in walking steps between the initial and the final week were estimated using multiple and multilevel regression analyses. Results Of the 416 participants, walking step data of 203 participants who completed postintervention assessments were included in the analyses. Multiple regression analysis of the average walking steps showed that the number of days with recorded steps was positively correlated with the log-transformed average walking steps (β=.01, P Conclusions This study showed that the elements accounting for high average walking steps and those preventing the decrease in walking steps from the initial to the final week differed. Behavioral characteristics correlated positively with average walking steps. Team characteristics (ie, regular communication and a smaller team size) significantly correlated with preventing a decrease in walking steps.

BACKGROUND The health conditions of Japanese salespersons may be adversely affected by their lifestyle. Face-to-face or on-site health interventions are not convenient for salespersons because of their tendency for out-of-office sales. Previous studies showed that mobile health (mHealth) interventions (compared to usual practice) have great potential to promote physical activity. For Japanese salespersons, mHealth can offer additional convenience to change their physical activity habits because they can access the mHealth contents anytime and anywhere. However, the specific elements that are most important to maintain physical activity levels using an mHealth approach remain unclear. OBJECTIVE We aimed to identify elements that account for both a high average physical activity level and can help to prevent a decrease in physical activity during a 9-week intervention period. METHODS Salespersons were recruited from 11 Japanese companies. A team-based walking intervention was held from October to December 2018 (for a total of 9 weeks), during which the walking step data were recorded by smartphone apps. Average walking steps of each participant during the intervention and the difference in walking steps between the initial and the final week were respectively used as dependent variables. The effects of team characteristics (ie, frequency of communication with team members and team size) and behavioral characteristics (ie, number of days with recorded steps on the apps) on the average walking steps, and the difference in walking steps between the initial and the final week were estimated using multiple and multilevel regression analyses. RESULTS Of the 416 participants, walking step data of 203 participants who completed postintervention assessments were included in the analyses. Multiple regression analysis of the average walking steps showed that the number of days with recorded steps was positively correlated with the log-transformed average walking steps (β=.01, PP=.03), and being on a larger team correlated with a decrease in walking steps from the initial to the final week (β=–328.4, P=.01). CONCLUSIONS This study showed that the elements accounting for high average walking steps and those preventing the decrease in walking steps from the initial to the final week differed. Behavioral characteristics correlated positively with average walking steps. Team characteristics (ie, regular communication and a smaller team size) significantly correlated with preventing a decrease in walking steps.

Background The uneven geographical distribution of physicians in Japan is a result of those physicians electing to work in certain locations. In order to understand this phenomenon, it is necessary to analyze the geographic movement of physicians across the Japanese landscape. Methods We obtained individual data on physicians from 1978 to 2012 detailing their attributes, work institutions, and locations. The data are from Japanese governmental sources (the Survey of Physicians, Dentists, and Pharmacists). The total sample size was 122 150 physicians, with 77.5% being male and 22.5% female. After obtaining the data, we calculated the geographical distance of each physician’s movement by using geographic information systems software (GIS; ArcGIS, ESRI, Inc., CA, USA). Geographical distance was then converted into time distance. We compared the resulting median values through nonparametric testing and then conducted a multivariate analysis. Our next step involved the use of an age-period-cohort (APC) model to measure the degree of impact three points of data, experience (experience years), the historical and environmental context of the data (survey year), and physician cohort (registration year) had on the movement of each physician. Results The ratio of female physicians who selected an urban area as their first working location was higher than that of male physicians. However, the selection of an urban area was becoming more popular as a first working location for both males and females as the year of data increased. The overall distance of geographical movement for female physicians was less than it was for male physicians. Physicians moved the greatest distance between their second and fourth years following license acquisition, at which point the time distance became shorter. The median time distance was 46 min in 2000 and 22 min in 2008. The physicians in our study did not move far from their first working location, and the overall distance of movement lessened in the more recent years of study. The median distance of movement after 20 years was 25.9 km for male physicians, and 19.1 km for female physicians. The results of the APC model indicated that the effects of experience years (age) gradually declined, that the survey year (period) effects increased, and that the registration year (cohort) effects increased initially before leveling off. Conclusions The trends following the introduction of the new mandatory training system in 2004 may imply that the concentration of physicians in Japan’s urban areas is expected to increase. After 2000, the effect of that period on physicians explains their geographical movements more so than the factor of their age.

Accessibility to healthcare service providers, the quantity, and the quality of them are important for national health. In this study, we focused on geographic accessibility to estimate and evaluate future demand and supply of healthcare services. We constructed a simulation model called the patient access area model (PAAM), which simulates patients’ access time to healthcare service institutions using a geographic information system (GIS). Using this model, to evaluate the balance of future healthcare services demand and supply in small areas, we estimated the number of inpatients every five years in each area and compared it with the number of hospital beds within a one-hour drive from each area. In an experiment with the Tokyo metropolitan area as a target area, when we assumed hospital bed availability to be 80%, it was predicted that over 78,000 inpatients would not receive inpatient care in 2030. However, this number would decrease if we lowered the rate of inpatient care by 10% and the average length of the hospital stay. Using this model, recommendations can be made regarding what action should be undertaken and by when to prevent a dramatic increase in healthcare demand. This method can help plan the geographical resource allocation in healthcare services for healthcare policy.

To investigate the career pathways of board-certified surgeons’ and the factors associated with them maintaining their certification in Japan. We analyzed data from the surveys of physicians, dentists and pharmacists. A multivariate logistic regression model was used to investigate whether factors such as gender, year of registration, place of work, and subspecialty board certification were associated with maintaining board certification. Most Japanese surgeons attain board certification within 5–10 years of initial medical registration. After adjusting for possible confounding factors, the odds of maintaining board certification were significantly lower for women, those who were beyond 20 years post-registration, those who worked in hospitals other than academic hospitals or clinics, and those who had board certification in surgery only. Of the total board-certified surgeons analyzed, 93.2 % continued to work in hospitals and 2.8 % moved to clinics within 2 years. Of those who moved from hospitals to clinics, half continued to practice surgery, while nearly 40 % changed their specialty to internal medicine. It is necessary to establish a special training system for mature surgeons who move from surgery to general practice later in their careers. As the number of female surgeon increases, a support system is also required to secure the future supply of surgeons.

This study was supported by Health Labour Sciences Research Grant of the Ministry of Health, Labour and Welfare, Tokyo, Japan (H25 - Research on Region Medical - 006).

Background The board certification system serves as a quality assurance system for physicians, and its design and operation are important health policy issues. In Japan, board certification was established and operated independently by academic societies and has not been directly linked to reimbursement systems. The phenomenon of younger physicians seeking specialist careers has raised concerns about acceleration of the tendency of fewer physicians working in rural areas and the maldistribution of physicians. Little is known about the associations between physicians’ geographical migration patterns and board certification status changes or between the continuation of urban/rural practice and the maintenance of board certification. This study aimed to identify these associations and to discuss their policy implications. Methods We analyzed 2012 and 2014 data from the Survey of Physicians, Dentists, and Pharmacists, a national census survey. To analyze geographical migration patterns, transitions in practice location (rural, intermediate, and urban) were analyzed by board certification status change (new, lost, consistently certified, and consistently uncertified). Logistic regression analysis was conducted to assess whether the odds of migrating to more urban/rural municipalities were associated with board certification status changes, adjusting for covariates, and whether practicing in a rural area was associated with maintaining board certification. Results Among 18,726 newly board-certified physicians, 94.9% (13,435/14,150) of those working in urban areas before certification remained in urban areas, whereas 64.6% (393/608) of those working in rural areas stayed in rural areas. Those who were newly certified had higher odds of moving to more urban areas, adjusting for covariates. Those who stayed in rural areas showed lower odds of maintaining board certification, adjusting for covariates. Conclusions Newly board-certified physicians are more likely to migrate to other types of areas, particularly more urban areas, than other physicians. Allocating more training quotas to rural areas could be one option for leveling the distribution of specialists. It also appeared that those practicing in rural areas have difficulty maintaining their certification, so the need to establish a support system for already-certified physicians in rural areas should be emphasized. Electronic supplementary material The online version of this article (10.1186/s12913-018-3441-y) contains supplementary material, which is available to authorized users.

In this study, we developed the Patient Access Area Model by using a Geographic information system (GIS), and, in order to evaluate the balance of medical supply and demand in the future in small areas, simulated patients’ access to hospitals. We set the accessible area by patients’ transit time for each hospital. The patients living in each 500 meters mesh were allowed to enter hospitals only within the access area. The hospitals have its limit to admit patients based on their actual numbers of beds. We distributed inpatients from each mesh across hospitals. For the evaluation of demand, if patients could not be distributed to the hospitals within the accessible area, we defined the situation as “over-demand.” As a result, although it was expected that over 9000 inpatients will not receive inpatient care in a southwest area region in the studied prefecture, most of the over-demand is in the densely regions along large traffic lines in 2030. Using this model, we can know demand for local health resources more clearly. This method is very useful to plan geographical resource allocation in medical services.

Background The percentage of females in the physician workforce is increasing in Japan, as in other countries; however, the working status of female physicians has not been sufficiently investigated. Methods Original data were obtained from the National Survey of Physicians (NSP) conducted by the Ministry of Health, Labour and Welfare, Japan, from 1984 to 2004. We examined the trend of female physicians’ areas of practice and analyzed their leave, return to work, and change in areas of practice using cohort data. Results The percentage of female physicians has increased significantly in recent generations, especially in surgery, surgical subareas of practice, and obstetrics and gynecology. A remarkable increase was found in obstetrics and gynecology among women under 29 years old from 15.4 to 66.2%. The total number of female physicians on leave has been higher than the number of female physicians returning since 1998. The average percentage of those who changed their area of practice was high in surgery (20.7%) and low in pediatrics (5.0%) and obstetrics and gynecology (1.7%). Conclusions A strategic plan is needed for future health policy to plan for the physician workforce, especially for the areas of practice with increasing proportions of young female physicians.

Purpose To investigate career trends for physician-scientists in Japan. Method The authors analyzed 1996-2008 biennial census survey data from Japan's national physician registry to examine trends over time in the numbers and proportion of physician-scientists by sex and years since registration. They also analyzed the transition of registered physicians into and out of the physician-scientist field across two sets of two consecutive surveys (1996-1998 and 2006-2008). Results The number of physician-scientists between 1996 and 2008 was stable, with a low of 4,893 and a high of 5,325. The number of younger physician-scientists (those registered 0-4 years at the time of the surveys) declined sharply, however, from 828 in 1996 to 253 in 2008. The number of female physician-scientists increased from 528 in 1996 to 746 in 2008. Across the two survey periods, about 30% of physician-scientists left the career path, but this attrition was offset by about the same number of new individuals entering the field. Conclusions Although the total number of physician-scientists was relatively unchanged during the period studied, it is essential that educators and policy makers develop approaches to address underlying demographic changes to ensure an adequate age- and gender-balanced supply of physician-scientists in the future.

Background In Japan, the number of obstetrics facilities has steadily decreased and the selection and concentration of obstetrics facilities is progressing rapidly. Obstetrics services should be concentrated in fewer hospitals to improve quality of care and reduce the workload of obstetricians. However, the impact of this intensification of services on access to obstetrics hospitals is not known. We undertook a simulation to examine how the intensification of obstetrics services would affect access to hospitals based on a variety of scenarios, and the implications for health policy. Methods The female population aged between 15 and 49 living within a 30-min drive of an obstetrics hospital was calculated using a Geographic Information System for three possible intensification scenarios: Scenario 1 retained facilities with a higher volume of deliveries without considering the geographic boundaries of Medical Service Areas (MSAs, zones of healthcare administration and management); Scenario 2 prioritized retaining at least one hospital in each MSA and then retained higher delivery volume institutions, while Scenario 3 retained facilities to maximize population coverage using location-allocation modeling. We also assessed the impact of concentrating services in academic hospitals and specialist perinatal medical centers (PMCs) alone. Results In 2011, 95.0 % of women aged 15–49 years lived within a 30-min drive of one of 1075 obstetrics hospitals. This would fall to 82.7 % if obstetrics services were intensified into academic hospitals and general and regional PMCs. If 55.0 % of institutions provided obstetrics services, the coverage would be 87.6 % in Scenario 1, whereas intensification based on access would achieve over 90.5 % coverage in Scenario 2 and 93.9 % in Scenario 3. Conclusions Intensification of obstetrics facilities impairs access, but a greater caseload and better staffing have the potential advantages of better clinical outcomes and reduced costs. It is essential to consult residents of hospital catchment areas when reorganizing clinical services; a simulation is a useful means of informing these important discussions.

OBJECTIVES This study analyses and discusses recent changes in young Japanese doctors' career paths, in terms of their distribution in different types of facilities and specialties, following changes to the postgraduate clinical training system in 2004. METHODS Data from the National Survey of Physicians, Dentists and Pharmacists conducted by Japan's Ministry of Health, Labour and Welfare were used for this study. RESULTS After the introduction of the new postgraduate training system, 2 years of clinical training became mandatory and a doctor-to-facility matching system was introduced. Since then, more young doctors have migrated from academic hospitals to non-academic hospitals. The number of first-year doctors at non-academic hospitals increased, whereas the number at academic hospitals decreased. In terms of the distribution of doctors per specialty, the decreasing tendency of doctors to choose internal medicine and surgery has accelerated. These results illustrate the significant changes that have affected young doctors' career paths since the new system was introduced. CONCLUSIONS Designing and providing desirable postgraduate clinical training and achieving appropriate doctor distribution are important policy issues. Appropriate policy interventions regarding a mechanism to ensure the appropriate distribution of doctors should be established and attention should be paid to expanding doctors' choices and increasing patient satisfaction and general cost-effectiveness.

In 2004, a new postgraduate medical training system was introduced in Japan and a shift of new graduates from university hospitals to other postgraduate education hospitals happened.The aim of this study is to analyse the past trends on postgraduate medical education choices and subsequent career options to discuss possible outcomes of the current shift and policy implications.Data from the national physician survey from 1976 to 2006 were analysed. The proportion change of physicians started their career in university hospitals was calculated. The career paths for physicians by different residency type were presented.More than 90% of physicians experienced university hospital work at least once in their 20-year careers. In their first 10 years of their career, physicians who started their residency in a university hospital tended to spend more years working in university hospitals, and those who started in other post-graduate training hospitals tended to spend less in university hospitals. Then, these groups presented quite similar patterns in their career choices.University hospitals need to strengthen their function as continuing education and career development centres and to adopt a less paternalistic approach, as fewer residents start their career in university hospitals.

Aim: A shortage of obstetricians and gynecologists (OB/GYNs) in Japan has been highlighted. We conducted a descriptive and retrospective cohort study using data from the Survey of Physicians in Japan, and analyzed the dynamics of OB/GYNs. Methods: We calculated the total numbers of OB/GYNs, their average age, the percentage of female OB/GYNs, hospital OB/GYNs, and the number of OB/GYNs in rural areas in 1974, 1984, 1994 and 2004. We determined the number of physicians who participated in and left the specialty of obstetrics and gynecology. The withdrawal rates of OB/GYNs who graduated in 1972, 1982 and 1992 were retrospectively followed using survival analysis. Results: The overall number of physicians has increased, while the number of OB/GYNs has remained almost unchanged over the past 30 years. The percentage of female OB/GYNs has increased. Fewer new graduates chose obstetrics and gynecology, the withdrawal rate of current OB/GYNs decreased, and their average age (50.8 years) increased. The trend in withdrawal rates did not differ significantly among the generations. Conclusions: The gravest problem in the OB/GYNs workforce is the continued decline in newly graduated OB/GYNs. Improvements in working conditions and job satisfaction are considered vital.

Introduction Previous reports (1996, 1997) have revealed that the market prices of medical materials in Japan were two to four times higher than those in the US. The Japanese government introduced the foreign price adjustment rule (FPA) in 2002 to reduce reimbursement prices in Japan. We aimed to investigate the current price differences between Japan and the US in the first half of 2005 and to evaluate the effectiveness of the FPA. Methods The investigation was performed at two joint purchasing organizations (JPO) and a hospital group in the US, and at a university hospital in Japan. Forty-one items in 14 categories were selected in advance. Results The price ratio (Japanese price/US price) was largest at 4.5–6.8 for percutaneous transluminal coronary angioplasty (PTCA) balloon catheters and 1.4–6.0 for vascular grafts. The price ratio was smallest at 1.2–2.4 for automatic sutures, 1.4–1.6 for Swan-Ganz catheters, and 1.5–2.3 for mechanical valves. Discussion The price differences between Japan and the United States were found to have rather widened with the exception of the pacemaker, because their market prices decreased more markedly in the United States. The investigation suggests several problems with the FPA: (1) the determination process of reimbursement prices is inappropriate, which has made the Japanese market less competitive, (2) the FPA needs too much time for the resolution of price differences, and (3) price data collected according to the FPA lacks strictness. Conclusions The high prices of medical material in Japan need to be adjusted down with more appropriate measures such as the full cost or cost inclusion methods.

Breast cancer screening with mammography has been shown to be effective for preventing breast cancer death. However, mammography screening can be harmful to women. One of the major problems is anxiety from a false positive result. Previous studies do not consider intangible benefits related to anxiety or peace of mind in mammography screening. In order to quantify anxiety, we employed the contingent valuation method (CVM) to measure the␣general public’s willingness to pay (WTP) for mammography screening. About 397 women aged 50–59 participated in the computer-assisted questionnaire survey. For the WTP question format, the double-bound dichotomous choice approach was employed. Participants were randomly assigned into 2 groups. Group A (n = 200) was provided with information about the procedure, detection rate and mortality reduction of mammography screening. Group B (n = 197) was provided with additional information including possibility of false positives and the risks of close examinations. The mean WTP was significantly greater in Group A than in Group B ($16.82 vs. $12.89, P = 0.02). A Weibull regression analysis showed that, type of information, history of receiving mammography screening, family history of cancer, and the degree of concern about health were significant factors affecting WTP. Women must be well informed before making decisions about mammography screening. Although anxiety from information about false positives significantly decreased the women’s benefit, the amount of WTP in the well-informed group was still considerable. The results suggest that women can balance the anxiety against the effectiveness.

In 2003, the Diagnosis Procedure Combination (DPC)-based payment system was introduced on a trial basis in 82 major Japanese hospitals. We analyzed the influence of this system on hospital revenue and expenditure, focusing on whether it reduces the length of stay in hospital (LOS), particularly in the surgical sector.We studied 120 patients hospitalized at the University of Tokyo hospital between May and July 2003, including 93 surgical patients who underwent operations for gastric, colon, rectal, hepatic, or mammary carcinoma; arteriosclerosis obliterans; appendicitis; adult hernia inguinalis; or varicose veins, and 27 nonsurgical patients hospitalized for recurrent gastric carcinoma, ileus, appendicitis, or mild acute pancreatitis. We analyzed the changes in profit per day in patients with a reduced LOS using the simulation model.Reducing the LOS of the surgical patients resulted in a greater profit; however, there was minimal if any profit increase achieved by reducing the LOS of the medical patients. In fact, when material costs were high, profit decreased.The DPC-based payment system does not usually offer an economic incentive to shorten the LOS. Expanding our current system will reduce the LOS only in major hospitals, but it will reduce the national average LOS. Thus, the current DPC-based payment system needs to be improved further.

In 2003, a lump-sum payment system based on Diagnosis Procedure Combinations (DPC) was introduced to 82 specific function hospitals in Japan. While the US DRG/PPS system is a "per case payment" system, the DPC based payment system adopts a "per day payment." It is generally believed that the Japanese system provides as much of an incentive as the DRG/PPS system to shorten the average length of stay (LOS). We performed an empirical analysis of the effect of LOS shortening on hospital revenue and expenditure under the DPC-based payment system, particularly in cardiovascular diseases. We also point out fundamentally controversial aspects of the current system. A total 109 cases were selected from patients hospitalized at the University of Tokyo Hospital from May to July, 2003 and classified into one of three categories: (1) cardiac catheter interventions, (2) cardiac catheter examinations, and (3) other conservative treatments. We analyzed the changes in profit per day in cases of a reduction in average LOS and an increase in the number of cases. In category (1) profit increased significantly in conjunction with reduced LOS. In category (2) profit increased only minimally. In category (3), profit increased rarely and sometimes decreased. In cases of conservative treatment, profits sometimes decreased because an increase in material costs exceeded the increase in revenue. It therefore became clear that the DPC-based payment system does not decisively provide an economic incentive to reduce LOS in cardiovascular medicine.

We constructed a simulation model with a geographic information system (GIS) to predict the future shortage of beds in the Tokyo Metropolitan Area. With a grid square method, we calculated patient numbers for every 500 square meters of the Tokyo Metropolitan Area until 2040 and estimated whether those in need could be admitted to hospitals within an hour's drive from their homes. The simulation demonstrates that after 2025 many patients may not be able to find hospitals within this time framework. The situation will be especially serious in the center of Tokyo and along the railway lines, where many senior citizens reside. We can now apply this innovative GIS method in many fields and especially for the precise estimation of future demands for and supply of medical assistance.

A shortage of obstetricians with increased workload is a social problem in Japan. In response, the government and professional bodies have accelerated the 'selection and concentration' of obstetric facilities. The aim of this study was to evaluate the recent trend of selection and concentration.We used data on the number of deliveries and of obstetricians in each hospital and clinic in Japan, according to the Static Survey of Medical Institutions in 2005, 2008 and 2011. To evaluate the inter-facility equality of distribution of the number of deliveries, number of obstetricians and number of deliveries per obstetrician, Gini coefficients were calculated.The number of obstetric hospitals decreased by 20% and the number of deliveries per hospital increased by 26% between 2005 and 2011. Hospital obstetricians increased by 16% and the average number of obstetricians per hospital increased by 19% between 2008 and 2011. Gini coefficient of deliveries has significantly decreased. In contrast, Gini coefficient of deliveries per obstetrician has significantly increased. The degree of increase in obstetricians and of decrease in deliveries per obstetrician was largest at the hospitals with the highest proportion of cesarean sections. The proportion of obstetric hospitals with the optimal volume of deliveries and obstetricians, as defined by Japan Society of Obstetrics and Gynecology, was 4% in 2008, and it had doubled to 8.1% 3 years later.The selection and concentration of obstetric facilities is progressing rapidly and effectively in Japan.

Background It is unknown whether childhood physical development in Asian populations differs from western populations, since no longitudinal analysis has been performed in Asian countries yet. Utilizing the 21st Century Longitudinal Survey in Newborns, we studied the timing of adiposity rebound (AR) among Japanese children and determined whether AR occurs earlier in obese children compared to nonobese children. Furthermore, we identified important demographic, social, and lifestyle factors that affect their physical development. Methods We used data from the annual surveillance of Japanese children born in 2001, with 45,392 eligible subjects. We applied survival analysis to evaluate the AR and a trajectory method for the BMI transition across 5 ½ years. Time-dependent and time-independent factors affecting BMI changes were investigated using longitudinal analysis. Accounting for the known difference in prevalence between Japanese and Western children, we adopted a 95th percentile of BMI as criterion for obesity. Results Mean BMI at birth and at ages 1 ½, 2 ½, 3 ½, 4 ½, and 5 ½ years for all subjects were 12.6, 16.3, 16.1, 15.8, 15.5, and 15.4, respectively, showing a progressive reduction after 1 ½ years. However, among obese children at 5 ½ years, 39.6% had experienced AR as early as at age 4 ½ years. Controlling for sex, Cox’s proportional hazards model showed that obese children had a 48.5% higher hazard to experience AR than nonobese children. The difference in BMI transition between obese and non-obese children was also captured by a trajectory method. In longitudinal analysis, BMI was lower for children who had a longer gestational period whereas children who received parental care from non-family members gained higher BMI values. Conclusions With the 95th percentile cutoff for children obesity, obese Japanese children developed AR earlier than nonobese Japanese children, similar to those in Western countries reported in the literature. Primary caretakers and length of gestational period were the most important socio-demographic factors affecting physical development.

Objectives To investigate trends of specialty distribution and physicians’ career paths in Japan, and to discuss potential policy implications. Methods Distribution of main area of practice, relation between board-certified specialists and reported main area of practice, and migration of main area of practice by career stage were analyzed in data from the National Physician Survey, collected between 1996 and 2006. Results The percentages of physicians involved in internal medicine, surgery, neurosurgery, pediatrics, ophthalmology, obstetrics and gynecology and otorhinolaryngology decreased from 1996 to 2006. Overall, the numbers reported for the main area of practice matched the number of board-certified specialists. Among physicians who began their careers as internal medicine physicians in the 1996 registration cohort, the proportion of those engaged in internal medicine fell from 82.5% in 1996, to 43.6% in 2000, to 37.0% by their 10th year. Among five registration cohorts analyzed, 9.1–16.8% of the surgical specialties group switched their main area of practice to internal medicine within 10 years. Conclusions While there is a general trend toward specialization, it is important to balance between general practice and specialization to strengthen health care systems. Developing a certification system and maintaining the quality of specialist physicians are also crucial.

BACKGROUND Currently, there is a shortage of hospital pediatricians in Japan. In the present study, using data from the Survey of Physicians, Dentists, and Pharmacists in Japan, we analyzed the dynamics and distribution of pediatricians, using a time series approach. METHODS The total number of pediatricians, the ratios of hospital-working and female pediatricians, their mean age and geographic distribution in 1974, 1984, 1994, and 2004 were determined. The dynamics of pediatricians were analyzed by identifying the annual number of physicians participating in and withdrawing from pediatrics, and by following up withdrawal rates from pediatrics and movement rates from hospitals. The withdrawal rates of male and female pediatricians registered in 1992, 1994, and 1996 were also analyzed. RESULTS The number of pediatricians per 10,000 children increased from 1.9 to 7.4 between 1974 and 2004. The percentage of women among pediatricians was significantly higher than that of women among all physicians in 2004 (P < 0.01). The numbers of physicians who withdrew from pediatrics increased from the periods 1985-1994 to 1995-2004. Younger pediatricians tended to leave pediatrics earlier than elder pediatricians. There were no differences in the withdrawal rates of pediatricians between men and women registered in 1992, 1994, and 1996. CONCLUSIONS It is anticipated that the number of pediatricians in Japan will decrease in the near future unless practical strategies are implemented to improve the early withdrawal of younger pediatricians and the current working conditions of female pediatricians.