nan Masako

Facilitators and barriers in the humanization of childbirth practice in Japan

BackgroundHumanizing birth means considering womens values, beliefs, and feelings and respecting their dignity and autonomy during the birthing process. Reducing over-medicalized childbirths, empowering women and the use of evidence-based maternity practice are strategies that promote humanized birth. Nevertheless, the territory of birth and its socio-cultural values and beliefs concerning child bearing can deeply affect birthing practices. The present study aims to explore the Japanese child birthing experience in different birth settings where the humanization of childbirth has been indentified among the priority goals of the institutions concerned, and also to explore the obstacles and facilitators encountered in the practice of humanized birth in those centres.MethodsA qualitative field research design was used in this study. Forty four individuals and nine institutions were recruited. Data was collected through observation, field notes, focus groups, informal and semi-structured interviews. A qualitative content analysis was performed.ResultsAll the settings had implemented strategies aimed at reducing caesarean sections, and keeping childbirth as natural as possible. The barriers and facilitators encountered in the practice of humanized birth were categorized into four main groups: rules and strategies, physical structure, contingency factors, and individual factors. The most important barriers identified in humanized birth care were the institutional rules and strategies that restricted the presence of a birth companion. The main facilitators were womens own cultural values and beliefs in a natural birth, and institutional strategies designed to prevent unnecessary medical interventions.ConclusionsThe Japanese birthing institutions which have identified as part of their mission to instate humanized birth have, as a whole, been successful in improving care. However, barriers remain to achieving the ultimate goal. Importantly, the cultural values and beliefs of Japanese women regarding natural birth is an important factor promoting the humanization of childbirth in Japan.

The demand for medical care : evidence from urban areas in Bolivia

This research analyzes the determinants of demand for medical services in urban areas of Bolivia. It also examines the possible trade-offs between cost recovery and the use of health services for different age, sex, ethnic, and income groups. The data used are from the third year of the Encuesta Integrada de Hogares (EIH), a multipurpose household survey conducted by the statistical office in Bolivia and the World Bank. The data are used to estimate a multinomial logit model, and a nested multinomial logit model (choice of medical facilities by patients). The main empirical result of this research is that the demand for medical care is responsive to changes in price, but price elasticities are, in general, very low. This finding is comparable to that of research for other countries. Moreover, the price elasticity of demand falls as income rises. For children, the price elasticities are lower than for adults. Price elasticities do not vary much by ethnic group or gender, but estimation results show that Aymara speakers (an Indian group) are more likely to care for themselves. Probably there are cultural barriers that prevent Aymara speakers from seeking formal care. The results also show that income and education are also important determinants of demand for medical care. For children, mothers education is far more influential than fathers. Since price elasticities are so low, it suggests that there is potential for the Bolivian government to raise revenues by charging user fees. If additional revenues are not used to expand primary health care or to improve quality, imposing user charges on services may not substantially reduce inefficiency and/or inequity in the health sector.

An analysis of the length of hospital stay for cataract patients in Japan using the discrete-type proportional hazard model

We analyze the length of hospital stays of patients hospitalized for cataract and related diseases (Diagnosis Related Groups (DRG) 2041) in Japan, utilizing the data pertaining to 3436 patients on whom one-eye lens operations are performed. We use the discrete-type proportional hazard model to analyze variables that may affect the length of stay. We find that estimates of the Child and Other Facility Dummies are negative and significant. These variables affect the leaving rate and the length of stay. The length of stay also changes at age 40. With regard to the types of affiliated operations and treatments, the estimates of dummy variables are negative and significant at the 1% level. We also find large differences in the length of stay among hospitals, despite eliminating the influence of both the characteristics of the patient and the types of affiliated operations and treatments. The longest average length of stay is over 3.5 times as long as the shortest average length of stay. Finally, we analyze the factors pertaining to hospitals that may affect the length of stay. The estimates of the Profit and Cold Region dummies are negative and significant; in other words, the leaving rate is reduced and the length of stay is increased if the hospital becomes more profitable and is located in the cold regions of Hokkaido and Tohoku.

Evolving health policy for primary care in the Asia Pacific region

Most countries experience major challenges to their health systems. The factors behind this global trend are increasing health costs and diminished returns on healthcare investment for ageing populations. Where the primary healthcare function is formally structured in the health system, and professionals are educated for their specific tasks, the performance of the system is improved: better primary health care leads to better population health at lower healthcare costs.1 This makes strengthening primary health care a global strategy to secure sustainable care.2 The value of international collaboration in implementing primary healthcare policy was exemplified by the I LIVE PC conference in 2011 in Washington.3 A critical feature of this is the modification and adaptation of general principles to the prevailing local conditions: primary health care must be built up from the community level where it has to operate.4 For this, a good understanding of the existing health system is important in initiating reforms. There is growing insight in primary health care in Europe and North America,3,5 but data are scarce for many countries or regions.4 To address this, the World Organization of Family Doctors (WONCA) took the initiative to document how primary care is organised around the world, and created dialogues on how the values of primary care can be addressed within the constraints of different healthcare systems.6 A plenary symposium at the 2015 WONCA Asia Pacific regional conference in Taipei, Taiwan, offered an opportunity to compare the health systems of six member organisations of WONCA — China (Shanghai region), China (Hong Kong), Japan, Republic of Korea (South Korea), Singapore, and Taiwan — and document their experiences in the implementation of policy. The six presentations were structured on the format and method developed by the WONCA Working Party on Research. …

Primary Health Care and General Practitioners in Denmark Generating a High Level of National Happiness: A Study Tour to a Leading Country for Family Medicine

Every year, we tour a leading country for family medicine with new trainees and staff who join the Department of Community and Family Medicine at Fukushima Medical University. This time we visited Denmark. In Denmark, General Practitioners (GPs) see their patients by a list system. GPs work as a gatekeeper and solve many kinds of health problems. GP training is a 5-year program, and the training system is well established. It is usual for both GP trainees and their partners to work and raise their children during the training.

Development of Social Health Insurance Systems: Retracing Japan’s Experience

Since the Second World War, many developing countries have tried to introduce a healthcare system similar to those already established in developed countries. However, such a system has often tended to aim at people living in urban areas and not those in rural areas. Unlike many of these developing countries, Japan had already introduced a kind of universal health insurance system at the end of the 1930s and a more genuine universal insurance system in the early 1960s. Developing countries that are currently in the process of moving from a partial to a universal healthcare system would benefit significantly by drawing lessons from the Japanese experience.