2012 Volume 24 Issue 1 Pages 18-32
As a means of addressing the severe shortage of obstetrics and gynecology doctors in Japan, consolidation of obstetrics facilities has been promoted in recent years. However, since consolidation involves the closure of obstetrics departments in some medical institutions, it is likely to cause deterioration in health care access for pregnant women living in areas where consolidation takes place.
This paper analyzed the impact of health care access on the choice of medical institution among pregnant women living in areas where consolidation has taken place. We first examined the impact of geospatial factors from various aspects, such as hospital location, residence area, transportation means, change in distance to the hospital, and change in travel time to the hospital. How geographical restrictions resulting from consolidation affect pregnant women's choice of medical institution was evaluated in comparison with facilities factors. We then examined whether socioeconomic factors affect pregnant women's institution choice.
We classified medical institutions selected by pregnant women into two categories: hospitals continuing to provide obstetrical services after consolidation ("continuing hospitals after consolidation") and other medical institutions. The latter were further classified into three types: general hospitals with neonatal intensive care units (NICUs) ("other general hospitals with NICUs"), other general hospitals ("other general hospitals"), and maternity hospitals and clinics ("maternity hospitals/clinics"). We carried out analyses using a nested logit model.
Analyses revealed that for all types of medical institutions, pregnant women's choice behavior was influenced by not only geospatial factors, but also facilities factors, indicating that a distance-decay effect is not always present. It was also revealed that pregnant women choosing "continuing hospitals after consolidation" attached more importance to objective factors such as comprehensive medical care facilities/functions, whereas pregnant women choosing "other medical institutions" attached more importance to subjective factors (reputation, etc.) and waiting time.
