Journal of Public Health

, Volume 22, Issue 4, pp 361–370 | Cite as

Factors affecting regional variations in hospitalization expenditures of elderly residents in Japan

  • Etsu Goto
  • Jason Lee
  • Noriko Sasaki
  • Yuichi ImanakaEmail author
Original Article



The aim of this study was to examine the possible effects of healthcare resource factors, socioeconomic factors, and sociodemographic factors on variations in hospitalization expenditures of elderly patients in Japan at different levels of urbanization.

Subject and methods

A secondary analysis was conducted using data obtained from a regional health care cost report and the Portal Site of Official Statistics of Japan. The regional unit of analysis used was the secondary medical care area. We divided these areas into three groups based on their levels of urbanization (low, middle, and high urbanization), indicated by their respective population densities of inhabitable areas. Multiple linear regression models were used to analyze the candidate factors affecting per capita hospitalization expenditures of elderly residents.


The significance and magnitude of associations were observed to vary according to different levels of urbanization. Our findings showed that medical resource factors and sociodemographic factors were more influential in areas of low urbanization, whereas the number of hospital beds and socioeconomic factors appeared more influential in high urbanization areas.


Policies designed to contain healthcare expenditures should take regional characteristics and levels of urbanization into account in order to support the development and implementation of region-specific improvements that ensure affordable healthcare for the elderly.


Demography Health care financing Health disparities Health services for the aged Utilization of health services 


Conflict of interest

The authors declare that they have no conflict of interest.


This work was supported in part by a Health Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Etsu Goto
    • 1
  • Jason Lee
    • 1
  • Noriko Sasaki
    • 1
  • Yuichi Imanaka
    • 1
    Email author
  1. 1.Department of Healthcare Economics and Quality Management, Graduate School of MedicineKyoto UniversitySakyo-kuJapan

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