Regional assessment of medical care provision system by principal component analysis.

ABSTRACT

Introduction: The Japanese government has promoted policies ensuring standardized medical care across the secondary medical care areas (SMCAs); however, these efforts have not been evaluated, making the current conditions unclear. Multidimensional indicators could identify these differences; thus, this study examined the regional characteristics of the medical care provision system for 21 SMCAs in Hokkaido, Japan, and the changes from 1998 to 2018. Materials and Methods: This study evaluated the characteristics of SMCAs by principal component analysis using multidimensional data related to the medical care provision system. Factor loadings and principal component scores were calculated, with the characteristics of each SMCA visually expressed using scatter plots. Additionally, data from 1998 to 2018 were analyzed to clarify the changes in SMCAs' characteristics. Results: The primary and secondary principal components were Medical Resources and Geographical Factors, respectively. The Medical Resources components included the number of hospitals, clinics, and doctors, and an area's population of older adults, accounting for 65.28% of the total variance. The Geographical Factors components included the number of districts without doctors and the population and a land area of these districts, accounting for 23.20% of the variance. The accumulated proportion of variance was 88.47%. From 1998 to 2018, the area with the highest increase in Medical Resources was Sapporo, with numerous initial medical resources (-9.283 to -10.919). Discussion: Principal component analysis summarized multidimensional indicators and evaluated SMCAs in this regional assessment. This study categorized SMCAs into four quadrants based on Medical Resources and Geographical Factors. Additionally, the difference in principal component scores between 1998 and 2018 emphasized the expanding gap in the medical care provision system among the 21 SMCAs.