For achieving equity of the accessibility to primary healthcare, measuring potential geographical accessibility is essential. The provider-to-population ratio is the most frequently used measure. However, it is difficult to be used in closer region because it does not take into consideration the people and health services beyond its boundary. In order to overcome this problem, we measured the potential access to hospital, using both distance measures and the enhanced two-step floating catchment area (E2SFCA) method. The aim of this study was to compare the number of hospitals in the neighborhood and the E2SFCA score with regard to the amount and equity for access to hospitals. This descriptive study used publicly available data from 2010. The E2SFCA score and number of neighborhood hospitals were obtained from Tochigi province in Japan using a geographic information system. Dataset of four measures by each census tract was obtained. The measures were E2SFCA score, number of hospitals within the 5 km range, number of hospitals within the 10 km range, and number of hospitals within the 15 km range. Correlation and disparity analyses with the Lorenz curve and Gini coefficient were performed. The measures were obtained in a smaller area than municipality considering adjacent areas using a geographical approach. The E2SFCA score was 5.3 [3.2–7.3] hospitals/million (median [quantile range]), compared to 5.6 hospitals/million in total for the given district. The median number of hospitals within the 5 km, 10 km, and 15 km ranges were 1, 39, and 47, respectively. There was no hospital within the 5 km range in one third of the blocks. Both the number of hospitals within the 10 km range and those within the 15 km range were well correlated. Regional difference became smaller as the distance to count the number of hospitals increased. The gap between small number of hospitals and the high E2SFCA score indicated the location of community hospital in depopulated areas. The E2SFCA method is superior for analyzing spatial access to hospital, because it provides information in the closer sub-regions. Regional differences were hardly seen in access to hospital beyond the 10 km range. Further studies in other regions and countries are needed for precise assessment.

Background: A decrease in populations could affect healthcare access and systems, particularly in medically underserved areas (MUAs) where depopulation is becoming more prevalent. This study aimed to simulate the future population and land areas of MUAs in Japan. Methods: This study covered 380,948 1 km meshes, 87,942 clinics, and 8354 hospitals throughout Japan as of 2020. The areas outside a 4 km radius of medical institutions were considered as MUAs, based on the measure of areas in the current Japanese Medical Care Act. Based on the population estimate for a 1 km mesh, the population of mesh numbers of MUAs was predicted for every 10 years from 2020 to 2050 using geographic information system analysis. If the population within a 4 km radius from a medical institution fell below 1000, the institution was operationally assumed to be closed. Results: The number of MUAs was predicted to decrease from 964,310 (0.77% of the total Japanese population) in 2020 to 763,410 (0.75%) by 2050. By 2050, 48,105 meshes (13% of the total meshes in Japan) were predicted to be new MUAs, indicating a 31% increase in MUAs from 2020 to 2050. By 2050, 1601 medical institutions were tentatively estimated to be in close proximity. Conclusions: In Japan, the population of MUAs will decrease, while the land area of MUAs will increase. Such changes may reform rural healthcare policy and systems.

The frequency of use of emergency telephone consultation (ETC) services, which is a telephone triage system in Japan, was explored to determine age- and sex-related trends on symptoms/events among Japanese adults. Data were obtained from records of the initial year of ETC services in Saitama Prefecture (from October 2014 to September 2015). Residents who used the ETC services were divided into four age groups (20–39, 40–64, 65–74, and ≥75 years old). The number of calls per 1000 persons (call rate, CR) was compared between the groups. The annual CR for the top 10 symptoms/events were assessed. The annual CR was 2.6/1000 persons. The annual CR was significantly higher for women (2.9) than for men (2.3) (p < 0.05). ETC use was the highest in the 20–39 age group for both sexes (3.3 and 4.4 in men and women, respectively). All groups had fever, abdominal pain, and nausea/vomiting in common. In older adults, the frequency of events such as bruises and head injury was high. Women and younger adults tended to use ETC services. There were similarities and differences in symptoms/events among the groups, which should be recognized by call centers to help foster call center staff.

Background: Access to medical institutions is crucial to healthcare systems. Japan has universal health coverage and unrestricted access to medical institutions; patients can visit any medical institution without requiring referral letters. We developed the Japan- Spatial Accessibility Scale for Medical Institutions (J-AMI) to provide integrated spatial accessibility to multiple sized healthcare institutions. We also examined the association between the J-AMI and life expectancy. Methods: This study included 220,621 administrative census mesh blocks defined by address; 89,248 clinics and 8,181 hospitals across 47 provinces in Japan, with a total population of approximately 126 million. The road distance between the centre of each block and the nearest clinic was calculated and scored every 1 km. Hospitals were classified as secondary and tertiary hospitals based on the availability of emergency and critical care centres. Secondary and tertiary hospitals were scored every 2 and 4 km, respectively. The scores for clinics and secondary and tertiary hospitals (1-8 points each) were aggregated and scored using a mesh. The population-weighted municipal J-AMI (PWM-J-AMI) scores were calculated for each municipality. Correlations between the PWM-J-AMI scores and life expectancy by municipality were examined. Geographic information was analysed using ArcGIS Pro. Results: Median life expectancies for male and female individuals were 81.4 years (interquartile range [IQR]: 80.9-81.9 years) and 87.5 years (IQR: 87.2-88.0 years), respectively. The median PWM-J-AMI score was 9.5 (IQR: 5.4-14.5). The PWM-J-AMI scores were negatively correlated with male and female individual’s life expectancy by municipality (r=-0.29, p < 0.01 and r = 0.18, p < 0.01, respectively). Conclusions: The results suggest that the better a region’s access to medical care, the longer its life expectancy. Efficient medical institution allocation and telemedicine promotion may be essential to improving access. Key messages: • We developed the Japan- Spatial Accessibility Scale for Medical Institutions (J-AMI) to provide integrated spatial accessibility to multiple sized healthcare institutions, using ArcGIS Pro. • The PWM-J-AMI scores were negatively correlated with male and female individual’s life expectancy by municipality, which suggest that the better a region’s access, the longer its life expectancy.