Selection and concentration of obstetric facilities in Japan: Longitudinal study based on national census data
Aim: A shortage of obstetricians with an increased workload is a social problem in Japan. The government and professional bodies are trying to cope with this problem by accelerating “selection and concentration” of obstetric facilities. The aim of this study is to evaluate the recent trend of selection and concentration.
Methods: 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 equity of the number of deliveries, number of obstetricians and number of deliveries per obstetrician, Gini coefficients were calculated.
Results: 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 degrees of increase in obstetricians and of decrease in deliveries per obstetrician were largest at the hospitals with the highest proportion of cesarean sections. The proportion of obstetric hospitals with the “optimal volume” of deliveries and obstetricians defined by Japan Society of Obstetrics and Gynecology was 4% in 2008, and it had doubled to 8.1% three years later.
Conclusion: The selection and concentration of obstetric facilities is progressing rapidly and effectively in Japan.
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).
The Journal of Obstetrics and Gynaecology Research
This is the peer reviewed version of the following article: Masatoshi M., Soichi K., Shigeki M., Saori K., Hiroo I. and Hideo Y. (2014), Selection and concentration of obstetric facilities in Japan: Longitudinal study based on national census data. Journal of Obstetrics and Gynaecology Research, 41: 919–925, which has been published in final form at https://doi.org/10.1111/jog.12663. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
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