This study was aimed to analyze the relationships between average travel times to perinatal medical centers and perinatal outcome from the perspective of secondary medical districts in Japan, by using a geographical information system.

The median value of the travel time was 19.1 minutes, the average value was 24.1 (standard deviation 13.6), the minimum value was 6.1 minutes, and the maximum value was 67.8 minutes. We set the travel time to perinatal medical centers as explanatory variables, and the infant, neonatal and perinatal mortality rate as explained variables, and then calculated odds ratio of each mortality rate which showed over the third quartile using logistic regression analysis. As a result, in all of the indicators, the odds ratios tended to increase as the travel times became longer. We need to examine centralization of perinatal hospitals based on accessibility while maintaining the current outcome level.

Based on the assumption that hospitals for delivery will be centralized to perinatal medical centers, we analyzed travel time and its equality before and after the centralization using the Gini coefficient.

For the impact caused by centralization of hospitals for delivery, the average travel time increased from 11.5 minutes to 18.7 minutes, and the Gini coefficients ranged from 0.39 to 0.38. When we assumed the centralization of hospitals for delivery, the travel time became longer, but its inequality was no changes or slightly improved.

In order to ensure the safe and secure perinatal care system, we have to consider the reality in which medical resources necessary for perinatal care are insufficient. We need to examine the re-allocation of medical resources, including centralization of hospitals for delivery based on accessibility and its equality. Our findings can contribute to the decision-making process in regional health plan.

The purpose of this study is to clarify the education programs in management for hospital staff, especially focusing on accounting education. We interviewed 3 hospital group organizations conducting accounting education in 2015 - 2016. As a result, training was practiced under different kinds of policies in each hospital group. The hospital group A picked up the theme from a medium-term perspective for practical staff. The hospital group B provided the same program every year and an optional theme meaningful to managers and practical staff. The hospital group C trained to managers and practical staff in operations directly related work. These study results are indicated that the methods of accounting education in the hospital groups vary according to the policies of the groups. Additionally, the target of program is also different and the theme of program is focused on the individuality of each group.