OBJECTIVE: this study aims to investigate the accessibility of perinatal care services by local residents in Japan. METHOD: the analysis of this study is based on the geographical information system data collected as part of the collaborative fact-finding survey conducted by the Japan Society of Obstetrics and Gynecology, and the Japan Association of Obstetricians and Gynecologists in 2014. The residents' accessibility to perinatal care services was measured based on the pregnant women's travel time to the nearest medical institution by automobile. The results were analysed based on the average travel time across four types of medical institutions, namely comprehensive perinatal care medical institutions; general perinatal care medical centres; regional perinatal care medical centres; and medical institutions with more than ten full-time obstetrician and gynecologist affiliations. RESULTS: 91.7% of pregnant women spent less than 15 minutes in accessing comprehensive perinatal care medical institutions and only 0.3% spent more than 60 minutes. In contrast, 2.2% of pregnant women accessing general perinatal care medical centers and 17.2% accessing medical institutions with more than ten specialist affiliations spent more than 60 minutes in transit. CONCLUSION: it is beneficial to examine the variability in pregnant women's access to various types of perinatal care services in Japan. This type of quantitative finding is expected to induce further investigation in to and the revision of local perinatal care service guidelines and policies, which would in turn improve perinatal service delivery as part of the wider prefectural health care planning and implementation.

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This study investigated hospitals' attempt at developing retention management for medical staff following large-scale disasters. The impacts of five experiences, i.e., “miserable experiences,” “guilt,” “workplace changes,” “household changes,” and “changes in occupational feelings” on medical staff and its impact on their decision to quit was investigated. The survey was conducted via the Internet with doctors and nurses working at hospitals from five prefectures in eastern Japan during the Great East Japan Earthquake. Respondents included 62 participants (31 doctors and 31 nurses). Differences in mean scores, correlational and regression analyses were performed for each experience data obtained. Results revealed a considerable difference between doctors and nurses regarding their misery. Nurses, especially, were susceptible to stress due to miserable experiences following disasters. Hence, mental care was effective in preventing nurses from quitting. Furthermore, the enhanced effects for midterm and long-term retention management were effective measures against household changes and occupational feelings.

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As a result of review of criteria on "severity and degree of medical/nursing needs" for hospitalization basic charges at the revision of the medical fee in April 2014, issues such as admittance of patients with high nursing needs while maintaining higher rate of bed occupancy are noted. In order to address the issue, I have extracted the factors that predict a patient's state of post-operative care requirements using the DPC information and patient classification method II. As a result, a patients group with complex surgeries under general anesthesia and a group diagnosed to require postoperative management are extracted. The result also indicated concentrated screening of "MDC06: Digestive System, Hepatobiliary, and Pancreas disease" is important in efficient care unit operations.

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I compared the background population pre-earthquake and post-earthquake restoration at the evacuation directive area, and inspected possibility of the administration of the hospital. I estimated the background population pre-earthquake and post-earthquake restoration at Minamisoma Municipal Odaka Hospital and Imamura Hospital with Huff model. The background population around Minamisoma Municipal Odaka Hospital pre-earthquake was 11,683; if all of these persons return to the authorized areas, the total would reach 15,111, but a simulation based on a poll of refugees by the Reconstruction Agency suggests that only 2,700 would return. The Imamura Hospital area had a population of 14,112 pre-earthquake; if all of these persons return, the total would reach 13,538, but the same simulation suggests that only 2,937 would return. In both areas, a restoration of the population equivalent to that pre-earthquake seems unlikely. There is Minamisoma Municipal Hospital near, Minamisoma Municipal Odaka Hospital could theoretically partner with the former and reopen, but a restoration of Imamura Hospital would prove difficult.

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This study intends to reveal actual conditions surrounding the nation's perinatal medical care system, mainly from the perspectives of disparities among secondary medical care areas and assessment of medical resource intensity, by using the results of a fact-finding survey on facilities providing delivery care conducted by the Japan Society of Obstetrics and Gynecology and the Japan Association of Obstetricians and Gynecologists in 2014. As a result, it was again confirmed that there are large disparities among secondary medical care areas in terms of facilities providing delivery care, placement of doctors, a division of roles between hospitals and clinics, and scale of medical institutions. While the society and others have set a goal of increasing the number of local base hospitals dealing with delivery care, each of which is staffed with more than 10 full-time obstetrics and gynecology specialists, the number is limited as there are 145 such hospitals across the nation. The number of births in secondary medical care areas which have such hospitals was 573,865 in total, accounting for 56 percent of the total number of births across the nation, suggesting the necessity to consolidate medical institutions and expand their scales. When the Herfindahl Hirschman Index, or HHI, is used as an evaluation method for the intensity, the HHI was considered to be useful in comparing medical care areas where the number of deliveries are nearly equal and conducting time-series assessment. In addition, concerning the numbers of deliveries and full-time doctors per medical institution, the HHI was considered to be helpful as an index.

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To discuss the reform of the medical insurance system, it is important to estimate lifetime medical costs. However, when using receipt data, there are three problems to estimate lifetime medical costs. First, since there is no data covering from birth to death, we use longitudinal data with a few years and simulate lifetime medical costs using some random variables. Second, many studies are not robust and parametric. They use type 2 Tobit model and bivariate normal random variables to simulate lifetime medical costs. Third, to avoid the parametric problem, Eichner et al. (1996, 2002) apply semiparametric random variables based on the resemble sample. However, this method is statistically inconsistent. To simulate lifetime medical costs, this paper proposes a new method. We generalize the type 2 Tobit model using Hermite polynomials. In simulation, we propose semiparametric random variables which are generated by Metropolis-Hastings algorithm.

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This research was performed to seek useful findings for hospital management with comparing and analyzing several sites' DPC data within a hospital group. It was clarified that analyzing Yoshiki 1 file and E/F file in hospitalization period lead to widely providing information about not only patient condition, but also actual use of pharmaceutical products. Particularly, it was considered that the useful data for a ratio of long-term hospitalization to total number of hospitalization and difference of replacement rate to generic drugs between sites, which would be important data from the point of hospital management. These research results are indicated that the further suggestions could be proposed for use of DPC data.

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