Trends in the structural characteristics of healthcare and long-term care resources and expenditures in depopulated areas: A two-way fixed-effects analysis of nationwide municipal data in Japan, 2015-2022

Publication

Affiliations

Nana-r Home-visit Nursing Development Center
School of Medicine, Nara Medical University

Journal

Policy and Practice Studies

Year / Volume / Issue / Pages

2025 / 11 / 2 / 235-242

DOI

10.69287/ppseb.11.2_235

Publisher page

Open publisher page

Repository file

Manuscript type

Author Accepted Manuscript

Repository publication date

2026-08-20

License

Creative Commons Attribution 4.0 International

PDF

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Abstract

This study aimed to comprehensively describe and compare trends in healthcare and long-term care resources and expenditures between depopulated and non-depopulated areas in Japan. We analysed panel data for all 1,741 municipalities from 2015 to 2022. Using indicators of healthcare and long-term care resources and expenditures per population (or per population aged ≥ 65 years) derived from official statistics, we fitted a two-way fixedeffects model (municipality and year), including an interaction between the depopulated-area indicator and year to evaluate differences in annual trends. To control the type I error rate across multiple outcomes, we applied false discovery rate control using the Benjamini-Hochberg procedure. Depopulated areas were defined according to the national Act on Special Measures for the Promotion of Independence of Depopulated Areas. Standard errors were clustered by municipality. In depopulated areas, hospitals (β = 0.07), general clinics (β = 0.93) and home-care support clinics (β = 0.34) increased more than in non-depopulated areas, whereas growth in home-visit nursing agencies (β = –0.20) and home-visit nurses (β = –0.31) was slower. Regarding long-term care resources, beds in special nursing homes for older people (β = 0.20) and in long-term care facilities (β = 0.07) increased more in depopulated areas. For expenditures, increases in total medical expenditure (β = –3,305.21) and inpatient medical expenditure (β = –846.68) were smaller, whereas long-term care insurance benefits per recipient increased more (β = 9,123.19) in depopulated areas. These findings suggest a coexistence of healthcare retraction and long-term care expansion in depopulated regions, underscoring the need to strengthen the foundation for home-visit nursing, allocate resources with attention to geographic accessibility and conduct policy evaluations linked to outcomes such as avoidable hospitalisations.

Keywords

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