@article{oai:nsg.repo.nii.ac.jp:00005184,
 author = {淡島, 正浩 and 板垣, 匠 and 菅野, 涼夏 and 木下, 直彦 and Kinoshita, Naohiko and 瀧口, 徹 and Takiguchi, Toru and Awashima, Masahiro and Itagak, Takum and Sugano, Ryoka},
 issue = {2},
 journal = {新潟医療福祉学会誌, 1346-8774},
 month = {Nov},
 note = {application/pdf, 論文(Article), 75 歳以上の高齢者の二次医療圏単位の一人平均医療費（以下、ME75）は西日本と北海道が高く東日本が低い地理的不均一分布で、いわゆる西高東低北高と呼ばれている。しかし、地理的不均一分布の確認はマップによる視覚的確認が主体で、統計学を用いた客観的確認がなされていない。また需給要因等、原因の統計学的検証が不十分である。そこで ME75 の地理的不均一分布の統計的確認とその原因に関する解析を本研究の目的とした。地理的不均一分布の確認には、カイ二乗検定、2 値Moran’s I および空間的重回帰分析により交絡因子を調整した多変量地域集積性の定量分析を行うため、GeoDaシステムを利用した。二次医療圏単位でみた我が国の ME75 は明らかに西高東低北高型の地域集積性を呈し、その医療経済的な主因として療養病床、精神病床の人口比率が捉えられた。西日本の ME75 は地域包括ケアシステムで求められている高齢者の病院への高アクセス性の傍証とも考えられる。このため、西日本のシステムを東日本にも広げるのが地域包括ケアシステムの視点から好ましいのか、あるいは医療費高騰による我が国の医療システムの財源枯渇と崩壊を未然に防ぐため、西日本を東日本と同程度に抑制すべきか、いずれが正解であるのか、更なる研究が必要である。, The geographic distribution of the average cost of medical care for adults aged 75 years or older in individual secondary medical areas (ME75) across Japan is uneven: costs are high in western Japan and northern Japan (Hokkaido), and low in eastern Japan. However, this uneven geographic distribution has mainly been confirmed by visualization on a map and has not been objectively confirmed by statistics. Moreover, there has not been sufficient statistical analysis of causative factors such as supply and demand. This study aimed to confirm the uneven geographic distribution of ME75 and analyze the causes. The uneven geographic distribution was confirmed by the chi-squared test, bivariate Moran’s I, and quantitative analysis of multivariate geographic clustering with adjustment for confounding factors using spatial multiple regression analysis. The GeoDa system was used for this analysis. The geographic clustering of ME75 in individual secondary medical areas across Japan clearly showed costs were high in western and northern Japan and low in eastern Japan. The numbers of long-term care beds and psychiatric care beds relative to population size were identified as the main medical economic factors explaining this difference. The high level of accessibility of hospitals to the elderly that is demanded of integrated community care systems further supports the high ME75 in western Japan. It may be desirable to implement the western Japanese system in eastern Japan to achieve integrated community care systems, or perhaps costs in western Japan could be reduced to the level of eastern Japan as a precaution to prevent Japan’s medical care system from exhausting its funding and collapsing due to soaring medical costs. Further research will be necessary to determine the appropriate approach., 原著論文},
 pages = {16--24},
 title = {一人平均後期高齢者医療費の二次医療圏における地域偏在と医療・社会経済・生活習慣指標との関連},
 volume = {20},
 year = {2020}
}