title: Selection and concentration of obstetric facilities in Japan: Longitudinal study based on national census data.
abstract: OBJECTIVE
  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.
  
  
  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 equality of distribution 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 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.
  
  
  CONCLUSIONS
  The selection and concentration of obstetric facilities is progressing rapidly and effectively in Japan.
authors.affiliation: Department of Community-Based Medical System, Faculty of Medicine, Hiroshima University, Hiroshima, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Division of Health Policy and Management, Center for Community Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Soichi
authors.initials: S
authors.lastname: Koike
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Matsubara
authors.affiliation: Department of Public Health and Health Policy, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Saori
authors.initials: S
authors.lastname: Kashima
authors.affiliation: Department of Medical Community Network and Discharge, Chiba University Hospital, Chiba, Japan.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Ide
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
mesh_terms: D000328:Adult; D003151:Community Health Centers / Q000600:supply & distribution*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D019538:Health Care Surveys; D006284:Health Plan Implementation; D006295:Health Resources / Q000600:supply & distribution*; D006771:Hospitals, Maternity / Q000600:supply & distribution*; D006801:Humans; D007564:Japan; D008137:Longitudinal Studies; D008507:Medically Underserved Area; D009774:Obstetrics / Q000379:methods*; D009775:Obstetrics and Gynecology Department, Hospital / Q000600:supply & distribution*; D011247:Pregnancy; D000078329:Workforce
keywords: Japan; health policy; health resource; obstetric delivery; workload