Association Between Rurality and Financial Performance of Public Hospitals in Japan: A Nationwide Cross-Sectional...

Area of Science:

• Healthcare Management
• Health Services Research
• Rural Health Policy

Background:

• Sustainable healthcare delivery in rural Japan is a critical policy concern.
• The financial performance of essential public hospitals in these areas is understudied concerning geographic rurality.

Purpose of the Study:

• To investigate the association between the Rurality Index for Japan (RIJ) and financial deficits in public hospitals.
• To adjust for hospital size and bed occupancy rate in the analysis of rurality and financial performance.

Main Methods:

• Nationwide cross-sectional study using fiscal year 2022 data.
• Analysis of 643 public hospitals, defining deficits as a balance ratio < 100%.
• Multivariable logistic regression to assess the impact of RIJ quartiles, hospital size, and bed occupancy rates.

Main Results:

• Unadjusted analysis showed higher rurality was linked to increased ordinary deficits.
• Multivariable analysis revealed no significant independent association between RIJ and financial deficits.
• Larger hospitals (≥300 beds) and higher bed occupancy rates (≥65.6%) were associated with reduced odds of ordinary deficits.

Conclusions:

• Hospital size and bed occupancy rate are more significant predictors of financial sustainability than geographic rurality.
• These structural factors are crucial for ensuring the financial viability of public hospitals in Japan.