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Evaluation of regional variations in healthcare utilization


Supply-side factors related to regional variations in healthcare have been thoroughly documented in the current health economics literature. However, less attention has been given to demand-side factors. To determine the source of variations in patient-side (i.e., demand-side) healthcare decisions, this study explored individual decisions on healthcare utilization related to the screening and treatment of chronic conditions. We found that overall municipal variations in healthcare utilization were mainly explained by individual-level factors and that the contribution of regionally specific factors was less than 5% of total variation after controlling for individual-level factors. However, there is a difference in the magnitude of variations between diagnosis and treatment and by condition. Specifically, the regional variation in diagnoses is far smaller than that in treatment given a diagnosis, and the magnitude of variation is different across chronic conditions. If it is a public health goal to further reduce regional disparities in healthcare utilization, the findings suggest that interventions designed to control chronic conditions should emphasize treatment for a specific condition.

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Correspondence to Yoko Ibuka.

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Yoko Ibuka received support from the Open Research Areas program, and Yasumasa Matsuda received support from Grant-in-Aid for Scientific Research (B)17H01701, by the Society for the Promotion of Science. The authors declare no conflict of interest. The authors are grateful for the valuable comments we received from participants of the Japan–Singapore Academic Forum on Aging in 2018. JSTAR dataset was provided by the Research Institute of Economy, Trade and Industry. The authors thank Takaki Sato for his assistance in preparing a manuscript. This paper extends a working paper (Shoji and Ibuka 2017) in data and analyses.

Appendix 1

Appendix 1

See Table 4.

Table 4 Socioeconomic and demographic characteristics in 10 municipalities covered by JSTAR

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Ibuka, Y., Matsuda, Y., Shoji, K. et al. Evaluation of regional variations in healthcare utilization. Jpn J Stat Data Sci 3, 349–365 (2020).

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  • Regional variations
  • Demand-side
  • Healthcare utilization
  • Logistic regression