『保健医療科学』2026 Vol.75 No.2 p.186－187
＜研修報告＞
令和 7 年度専門課程Ⅰ
保健福祉行政管理分野
香川県における在宅医療提供量の二次医療圏別比較―
三好達也
Regional Variation in Home Medical Care Provision in Kagawa Prefecture
MIYOSHI Tatsuya
抄録
【緒言】高齢化の進展に伴い在宅医療の重要性が高まる一方，その提供体制には地域差が存在する．本研究は，標準化レセプト出現比（SCR）を用いて，香川県における在宅医療提供量を二次医療圏別に比較し，地域差の実態を把握することを目的とした．
【方法】香川県および県内３二次医療圏（東部，西部，小豆）を対象に生態学的研究を実施した．NDBオープンデータおよび内閣府公開データを用い，訪問診療および往診に該当する診療報酬項目のSCRを比較し，2019～2022年度の年次推移を記述的に分析した．
【結果】訪問診療および往診のSCRには二次医療圏間で明確な差が認められた．訪問診療は県全体として全国平均を下回り，特に小豆医療圏で低水準であった．一方，主治医以外による訪問診療は東部医療圏で高値を示した．年次推移では，往診は東部・西部医療圏で緩やかな低下傾向を示したが，小豆医療圏では増加傾向がみられた．
【結語】香川県における在宅医療提供量とその構成には二次医療圏ごとに地域差がみられ，人口構成や医療資源，地理的条件といった地域特性を反映している可能性が示唆された．SCRを用いた二次医療圏別分析は在宅医療提供構造の大枠を把握する上で一定の意義を有する一方，今後は市町村単位等のより細かな分析単位による検討が求められる．
キーワード: 在宅医療，標準化レセプト出現比，二次医療圏，地域差，NDBオープンデータ
Abstract
[Introduction] Home-based medical care is increasingly important in an aging society, yet its provision varies across regions. This study aimed to describe regional differences in home medical care provision in Kagawa Prefecture using standardized claim-data ratios (SCRs) at the secondary medical area level.
[Methods] We conducted an ecological study of Kagawa Prefecture and its three secondary medical areas (Eastern, Western, and Shozu). SCRs for home visit medical care and home visits on demand were obtained from NDB Open Data Japan and Cabinet Office datasets and compared across regions. Regional differences and annual trends from 2019 to 2022 were examined descriptively.
[Results] Clear regional variation was observed in SCRs for both home visit medical care and home visits on demand. Overall provision of home visit medical care in Kagawa Prefecture was lower than the national average, articularly in the Shozu area. In contrast, home visit medical care for residents of the same building showed relatively higher SCRs in the Eastern area. Over time, SCRs for home visits on demand declined slightly in the Eastern and Western areas, whereas a modest increasing trend was observed in the Shozu area despite low overall levels.
[Conclusion] The volume and structure of home-based medical care differed across secondary medical areas, suggesting that provision reflects regional characteristics such as population structure, medical resources, and geographic conditions. While SCR-based analysis at the secondary medical area level is useful for capturing the overall structure of home medical care provision, further analyses using smaller geograph ic units, such as municipalities, are warranted.
keywords: Home-based medical care, Standardized claim-data ratio (SCR) , Secondary medical area, Regional variation, NDB Open Data Japan