title: Evaluating the impact of health resource reconstruction on improving spatial accessibility of tuberculosis care.
abstract: In Japan, a decline in tuberculosis (TB) notification rates and shortening of duration of hospitalisation have led to a drastic decrease in the number of hospital beds for TB patients (TB beds), causing severe undersupply in certain regions.
  
  
  
  To assess the current status of spatial access to TB beds in Japan and evaluate the potential impact of health resource reconstruction in mitigating undersupply of TB beds.
  
  
  
  A cross-sectional study was conducted whereby a two-step floating catchment area (2SFCA) method was used to calculate an 'accessibility score' to evaluate spatial accessibility of TB beds in the regions classified by four levels of urbanisation. The impact of introducing 'potential TB beds' was assessed via the changes in the proportion of undersupplied regions and TB patients notified from undersupplied regions.
  
  
  
  Undersupplied regions were characterised by 'very low', 'low' and 'moderate' level of urbanisation. By introducing 'potential TB beds', the proportion of both undersupplied regions and TB patients could be significantly reduced, especially in less urbanised regions.
  
  
  
  Our results may be used to guide future decision-making over resource allocation of TB care in Japan. The 2SFCA method may be applied to other countries using appropriate demand and supply variables.
authors: Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis (RIT), Japan Anti-Tuberculosis Association (JATA), Tokyo, Japan; Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
authors: K
authors: K
authors: Izumi
authors: Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis (RIT), Japan Anti-Tuberculosis Association (JATA), Tokyo, Japan.
authors: L
authors: L
authors: Kawatsu
authors: Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis (RIT), Japan Anti-Tuberculosis Association (JATA), Tokyo, Japan; Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
authors: A
authors: A
authors: Ohkado
authors: Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis (RIT), Japan Anti-Tuberculosis Association (JATA), Tokyo, Japan.
authors: K
authors: K
authors: Uchimura
authors: Vice Director's Office, RIT, JATA, Tokyo, Japan.
authors: S
authors: S
authors: Kato
mesh_terms: D003430:Cross-Sectional Studies; D003657:Decision Making; D006295:Health Resources / Q000592:standards*; D006297:Health Services Accessibility / Q000592:standards*; D006760:Hospitalization; D006801:Humans; D007564:Japan / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*