ArticleInternational journal of health geographics2016
The effect of concentrating obstetrics services in fewer hospitals on patient access: a simulation.
Article in International journal of health geographics, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Assessing Task-Shifting Progress in Obstetrics and Gynecology: A Nationwide Survey of Japanese Obstetricians and Gynecologists.Healthcare (Basel, Switzerland) · 2025Article
- Does the reduction in obstetric hospitals result in an unintended decreased in-hospital delivery utilisation? A causal multilevel analysis in China.BMJ public health · 2025Article
- Factors associated with the closure of obstetric units in German hospitals and its effects on accessibility.BMC health services research · 2023Article
- The causal effect of delivery volume on severe maternal morbidity: an instrumental variable analysis in Sichuan, China.BMJ global health · 2022Article
- Weekend and off-hour effects on the incidence of cerebral palsy: contribution of consolidated perinatal care.Environmental health and preventive medicine · 2020Article
- Factors affecting the provision of analgesia during childbirth, Japan.Bulletin of the World Health Organization · 2019Article
- Challenges in providing maternity care in remote areas and islands for primary care physicians in Japan: a qualitative study.BMC family practice · 2018Article
- Health research needs more comprehensive accessibility measures: integrating time and transport modes from open data.International journal of health geographics · 2016Article
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Authors and funding
6 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundIn Japan, the number of obstetrics facilities has steadily decreased and the selection and concentration of obstetrics facilities is progressing rapidly. Obstetrics services should be concentrated in fewer hospitals to improve quality of care and reduce the workload of obstetricians. However, the impact of this intensification of services on access to obstetrics hospitals is not known. We undertook a simulation to examine how the intensification of obstetrics services would affect access to hospitals based on a variety of scenarios, and the implications for health policy.
methodsThe female population aged between 15 and 49 living within a 30-min drive of an obstetrics hospital was calculated using a Geographic Information System for three possible intensification scenarios: Scenario 1 retained facilities with a higher volume of deliveries without considering the geographic boundaries of Medical Service Areas (MSAs, zones of healthcare administration and management); Scenario 2 prioritized retaining at least one hospital in each MSA and then retained higher delivery volume institutions, while Scenario 3 retained facilities to maximize population coverage using location-allocation modeling. We also assessed the impact of concentrating services in academic hospitals and specialist perinatal medical centers (PMCs) alone.
resultsIn 2011, 95.0% of women aged 15-49 years lived within a 30-min drive of one of 1075 obstetrics hospitals. This would fall to 82.7% if obstetrics services were intensified into academic hospitals and general and regional PMCs. If 55.0% of institutions provided obstetrics services, the coverage would be 87.6% in Scenario 1, whereas intensification based on access would achieve over 90.5% coverage in Scenario 2 and 93.9% in Scenario 3.
conclusionsIntensification of obstetrics facilities impairs access, but a greater caseload and better staffing have the potential advantages of better clinical outcomes and reduced costs. It is essential to consult residents of hospital catchment areas when reorganizing clinical services; a simulation is a useful means of informing these important discussions.
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