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. 2025 May 9;25(1):667.
doi: 10.1186/s12913-025-12848-w.

Rural and urban disparities in access and quality of healthcare in the Japanese healthcare system: a scoping review

Makoto Kaneko  1   2   3 , Ryuichi Ohta  4 , Maria Mathews  5
Affiliations

Rural and urban disparities in access and quality of healthcare in the Japanese healthcare system: a scoping review

Makoto Kaneko et al. BMC Health Serv Res. .

Abstract

Background: The rural-urban disparity in healthcare quality is a global issue. Compared with living in urban areas, living in rural areas is associated with poorer healthcare outcomes. Moreover, the shortage of healthcare providers in rural areas is a worldwide concern. This scoping review aims to map existing evidence regarding rural-urban disparities in access and quality of healthcare in Japan using the Donabedian model as a theoretical framework and to identify conceptual and measurement gaps.

Methods: This review targeted published articles and gray literature. We included documents that (1) were based on Japanese populations and (2) compared the quality of care between defined rural and urban areas. We excluded articles if they (1) were published during or before 2005 since the Japanese government amended the Medical Care Law in 2006; (2) focused exclusively on urban or rural areas; or (3) were not published in English or Japanese. This study employed PubMed, EMBASE, Web of Science, the Japanese medical literature database, ICHUSHI, and CiNii Research. We extracted quality indicators (structure, process, and outcomes) based on the Donabedian model. We recorded the definitions or indicators of rurality described by the studies.

Results: Out of 5,020 articles, 15 were included. Only one study was conducted in a primary care setting. Moreover, no study evaluated the "outcomes" of the Donabedian model in a primary care setting. Regarding the definitions or indices of rurality, the most commonly used indicator of rurality was population size, followed by population density. The cutoff values or descriptions of rurality using these indicators differed across studies.

Conclusion: This study mapped rural-urban disparities in access and quality of healthcare in Japan. These findings highlight the need to evaluate rural-urban disparities in the "outcomes" of care in primary care settings in Japan and the lack of common indicators of rurality.

Keywords: Healthcare; Japanese; Rural-urban; Rurality index; Scoping review.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: An ethics committee did not assess the study since we only used published literature or websites and did not handle personal information or human biological samples. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram for the selection of studies in the scoping review
Fig. 2
Fig. 2
Sankey diagram of the included studies and the Donabedian domains they address. blue: structure, green: process, orange: outcomes
Fig. 3
Fig. 3
Definitions or indices of rurality used in the included studies
Fig. 4
Fig. 4
Breakdown of domains of the Donabedian model
See this image and copyright information in PMC

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References

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