title: The effect of centralization of health care services on travel time and its equality.
abstract: OBJECTIVE
  To analyze the regional variations in travel time between patient residences and medical facilities for the treatment of ischemic heart disease and breast cancer, and to simulate the effects of health care services centralization on travel time and equality of access.
  
  
  METHODS
  We used medical insurance claims data for inpatients and outpatients for the two target diseases that had been filed between September 2008 and May 2009 in Kyoto Prefecture, Japan. Using a geographical information system, patient travel times were calculated based on the driving distance between patient residences and hospitals via highways and toll roads. Locations of residences and hospital locations were identified using postal codes. We then conducted a simulation analysis of centralization of health care services to designated regional core hospitals. The simulated changes in potential spatial access to care were examined.
  
  
  RESULTS
  Inequalities in access to care were examined using Gini coefficients, which ranged from 0.4109 to 0.4574. Simulations of health care services centralization showed reduced travel time for most patients and overall improvements in equality of access, except in breast cancer outpatients.
  
  
  CONCLUSIONS
  Our findings may contribute to the decision-making process in policies aimed at improving the potential spatial access to health care services.
authors.affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan. Electronic address: kobayashi-d@umin.ac.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
authors.affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan. Electronic address: otsubo-kyoto@umin.ac.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Otsubo
authors.affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan. Electronic address: imanaka-y@umin.net.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Imanaka
mesh_terms: D002497:Centralized Hospital Services; D040362:Geographic Information Systems; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D007345:Insurance Claim Review; D007564:Japan; D013997:Time Factors; D014195:Travel
keywords: Gini coefficient; Health care access; Regional variations; Travel time