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Impact of geographic accessibility on utilization of the annual health check-ups by income level in Japan: A multilevel analysis

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  • Misuzu Fujita
  • Yasunori Sato
  • Kengo Nagashima
  • Sho Takahashi
  • Akira Hata

Abstract

Although both geographic accessibility and socioeconomic status have been indicated as being important factors for the utilization of health care services, their combined effect has not been evaluated. The aim of this study was to reveal whether an income-dependent difference in the impact of geographic accessibility on the utilization of government-led annual health check-ups exists. Existing data collected and provided by Chiba City Hall were employed and analyzed as a retrospective cohort study. The subjects were 166,966 beneficiaries of National Health Insurance in Chiba City, Japan, aged 40 to 74 years. Of all subjects, 54,748 (32.8%) had an annual health check-up in fiscal year 2012. As an optimal index of geographic accessibility has not been established, five measures were calculated: travel time to the nearest health care facility, density of health care facilities (number facilities within a 30-min walking distance from the district of residence), and three indices based on the two-step floating catchment area method. Three-level logistic regression modeling with random intercepts for household and district of residence was performed. Of the five measures, density of health care facilities was the most compatible according to Akaike’s information criterion. Both low density and low income were associated with decreased utilization of the health check-ups. Furthermore, a linear relationship was observed between the density of facilities and utilization of the health check-ups in all income groups and its slope was significantly steeper among subjects with an equivalent income of 0.00 yen than among those with equivalent income of 1.01–2.00 million yen (p = 0.028) or 2.01 million yen or more (p = 0.040). This result indicated that subjects with lower incomes were more susceptible to the effects of geographic accessibility than were those with higher incomes. Thus, better geographic accessibility could increase the health check-up utilization and also decrease the income-related disparity of utilization.

Suggested Citation

  • Misuzu Fujita & Yasunori Sato & Kengo Nagashima & Sho Takahashi & Akira Hata, 2017. "Impact of geographic accessibility on utilization of the annual health check-ups by income level in Japan: A multilevel analysis," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-14, May.
    • Handle: RePEc:plo:pone00:0177091
    DOI: 10.1371/journal.pone.0177091
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    References listed on IDEAS

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    1. Coughlin, Steven S. & Leadbetter, Steven & Richards, Thomas & Sabatino, Susan A., 2008. "Contextual analysis of breast and cervical cancer screening and factors associated with health care access among United States women, 2002," Social Science & Medicine, Elsevier, vol. 66(2), pages 260-275, January.
    2. Misuzu Fujita & Yasunori Sato & Kengo Nagashima & Sho Takahashi & Akira Hata, 2016. "Income Related Inequality of Health Care Access in Japan: A Retrospective Cohort Study," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-19, March.
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    Cited by:

    1. Sharifah Saffinas Syed Soffian & Azmawati Mohammed Nawi & Rozita Hod & Huan-Keat Chan & Muhammad Radzi Abu Hassan, 2021. "Area-Level Determinants in Colorectal Cancer Spatial Clustering Studies: A Systematic Review," IJERPH, MDPI, vol. 18(19), pages 1-20, October.
    2. Antonio Paez & Christopher D Higgins & Salvatore F Vivona, 2019. "Demand and level of service inflation in Floating Catchment Area (FCA) methods," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-38, June.
    3. Durr-e-Nayab & Shujaat Farooq & Nabila Kunwal, 2024. "Utilisation Challenges of Public Health Insurance Initiatives: Evidences from Sehat Sahulat Programme (SSP) in Pakistan (Policy)," The Pakistan Development Review, Pakistan Institute of Development Economics, vol. 63(2), pages 247-288.
    4. Sarah Nurain Mohd Noh & Suhana Jawahir & Yeung R’ong Tan & Iqbal Ab Rahim & Ee Hong Tan, 2022. "The Health-Seeking Behavior among Malaysian Adults in Urban and Rural Areas Who Reported Sickness: Findings from the National Health and Morbidity Survey (NHMS) 2019," IJERPH, MDPI, vol. 19(6), pages 1-17, March.

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