Equal access to specialized care

Takaoka, Toyama

Regarding the March 3 article, “Cancer, heart disease, stroke deaths plunge to 50-year low“: People’s accessibility to specialized medical resources is essential. We have to pay more attention to regional disparities, which are partly caused by uneven distribution of clinical specialists. A variety of factors, such as lifestyles, eating habits, population structure and climate conditions, are related to the regional disparities in death rates from the country’s three major diseases. There is a limited availability of specialists, particularly for patients in rural areas.

Take stroke for example. According to the latest survey, the lowest rate in both men and women was recorded in Kanagawa Prefecture, while the highest rate is in Iwate. Although the number of doctors for every 100,000 people in Kanagawa (178.3) is fewer than in Iwate (186.8), the number of stroke specialists certified by the Japanese society of neurology are 306 and 58, respectively. For the Japanese society of internal medicine, the number of certified physicians is 920 in Kanagawa and only 74 in Iwate.

Given the lack of central control over the allocation of medical resources, it is not surprising that the quality of care varies from region to region. As patients have the right to get the right treatment at the right time, strategies to improve access to up-to-date medical services should involve programs aimed at reducing disparities in referrals to specialists for complicated treatments such as revascularization of coronary and cerebral arteries.

It is generally difficult to recruit specialists to work in rural areas, where resources are scarce, and opportunities to interact with specialist colleagues are limited. In this situation, new information-sharing paradigms will be necessary for doctors because recent medical advances are leading to an explosion of diagnostic, therapeutic and prophylactic innovations.

Effective use of telemedicine, including video-conferencing, might spread the specialty resources of an academic medical center to community-based hospitals. Establishing an adequate infrastructure might enable primary care physicians to provide complex care through regular access to clinical consultation and instruction from experts. Community-based hospitals could be perfect places for managing chronic conditions because they are culturally appropriate and geographically accessible for long-term care, particularly in rural areas. Providers at these centers can more easily build trust with patients.

If Japan sets up an agency that oversees treatments and outcomes at hospitals across the country, the behind-the-scenes reasons for regional disparities might come to light. We should turn our attention toward strategies for expanding best-practice care to as many patients as possible under the fundamental concept of a health care system with equal access for all.

The opinions expressed in this letter to the editor are the writer’s own and do not necessarily reflect the policies of The Japan Times.

hajime ichiseki