title: Non-physician communities in Japan: are they still disadvantaged?
abstract: BACKGROUND
  Non-physician community' (NPC) is a policy term that indicates a medically underserved area in Japan. Designated NPCs are politically targeted as the foci of medical resource allocation. NPC is defined as a specified district where 50 or more persons dwell within a geographic diameter of 4 km and medical care is not easily accessible. The definition of NPC was first introduced in 1960 and has been unchanged for more than half a century despite radical social changes in rural Japan. This study examines whether designated NPCs are still more disadvantaged in terms of geographical access to healthcare in comparison to other communities.
  
  
  METHODS
  Hiroshima prefecture, which has the largest number of NPCs in terms of tertiary healthcare areas of Japan, was used as the study area. Targeted communities were all the NPCs in the prefecture, and, as controls, two community groups were selected: non-NPC adjacent to NPC, and municipal center. We measured driving time from NPCs and control communities to the nearest healthcare facilities, which were classified into the following two types: primary or secondary care facilities (n=2636) and tertiary care facilities (equal to tertiary emergency care centers; n=6). We further calculated the driving time to the nearest facilities for secondary emergency care (n=246) extracted from the 2636 primary or secondary care facilities.
  
  
  RESULTS
  The median driving times to the nearest primary or secondary healthcare facility for NPC, non-NPC, and municipal center were 11 minutes, 11 minutes, and 1 minute, respectively; the times to a tertiary healthcare facility (equal to an accident and emergency care center) were 80 minutes, 84 minutes, and 68 minutes, respectively; and the times to a secondary emergency care facility were 24 minutes, 18 minutes, and 15 minutes, respectively. Although a municipal center was significantly more advantageous in driving time compared to a primary or secondary care facility, the disadvantage of a NPC in access was no more obvious than an adjacent non-NPC for any type of healthcare facility.
  
  
  CONCLUSIONS
  NPCs had a disadvantage in access time to primary, secondary and tertiary medical care compared with a municipal center. NPCs, however, did not have a greater access disadvantage in comparison to adjacent rural communities for any type of medical facility. As such, future resource allocation policies in Japan need to redefine medically underserved communities.
authors.affiliation: Department of Public Health and Health Policy, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan. saori_ksm@ybb.ne.jp.
authors.forename: S
authors.initials: S
authors.lastname: Kashima
authors.affiliation: Department of Community Medicine, Chiba Medical Center, Teikyo University School of Medicine, Chiba, Japan. kojanc@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Department of Community-Based Medical System, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan. matmo10@jb3.so-net.ne.jp.
authors.forename: M
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Department of Community-Based Medical System, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan. ktakeuchi@hiroshima-u.ac.jp.
authors.forename: K
authors.initials: K
authors.lastname: Takeuchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D040362:Geographic Information Systems; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007564:Japan; D008507:Medically Underserved Area; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult
keywords: Asia; Emergency Care; General/Family Practice; Health Needs Assessment; Health Service reform; Management/Administration; Public Health; Researcher