The Analysis of Medical Efficiency and Location Tendencyof the Medical Mall in Fukuoka CityDU Mengge (発表者) , Higuchi Go and ZHAO Shichen
Kyushu University
2020.04.11

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INTRODUCTION|BACKGROUND
Population Reduction

Aging Society
(%)
Japan
Germany
FranceSwedenBritishUSA

Aging Population in Developed Countries

The Tendency of Declining Population in Japan

Decrease of the total population in Japan from 2015, which means the depopulation becomes the new inevitable normal.
Meanwhile, the aging population is serious in Japan comparing with other developed countries.

MORE MEDICAL DEMENDThe Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City1INTRODUCTION|BACKGROUND
Insufficient Doctor

Concentrate on central area

Number of Doctor per 1,000 Residents in OECD Countries

The number of doctors per 1000 people is smaller than the other countries, ranking 62 in the world. Also less than theother OECD (Organization for Economic Co-operation and Development) countries.
Medical facilities are concentrate on the central urban area and many doctors choose to work in the central area.
INSUFFICIENT MEDICAL SUPPLYThe Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City

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INTRODUCTION|BACKGROUNDUNBALANCED SUPPLY-DEMAND

Dark Red
Supply>DemandLight Red
Demand>SupplyThe supply and demand of the medical resources are unbalanced in Fukuoka city.
There is another serious problem that the shortages resources in suburban areas.
The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City

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INTRODUCTION|MEDICAL MALL
A medical mall is a medical building or place gathering with 3 or more medical facilities such as clinics, dental clinicsand pharmacies, which contains 2 or more clinics. By integrating the medical resources of different departments
and improving the interaction mechanism between doctors and patients, the medical mall can realize theefficient sharing of medical resources and improve the relationship between doctors and patients.
PHARMACY

The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City

1INTRODUCTION|MEDICAL MALL
CHARACTERISTICü Medical testing facilities, receiving desks, management departments, pharmacies andother facilities are shared to save resources and improve efficiency. Doctors cancooperate with each other and the patients wait less time by the sharing reception andequipment.
ü Meet people’s diverse needs, for example, the elderly people can receive consultations
from several medical departments in one medical mall.

Ophthalmology
Internal Medicine
General Surgery

Pediatrics

Psychiatry
Dermatology

Number of Medicine types in each Age Category
The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City1INTRODUCTIONPURPOSE
Clarifying the medical efficiency of medical mall quantitatively and compare with other clinics.
Clarifying the location tendency of medical mall, based on the medical efficiency.

The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City2METHODOLOGY |RESEARCH OBJECT
Under such background and demand, thisstudy takes the medical facilities of Fukuoka,a typical local central city in Japan, as theresearch object, aiming to analyze theservice efficiency and spatial distribution
characteristics of the medical mall with thehelp of quantitative methods, and explore
the best location conditions.

The research targets are the clinics and themedical malls located in Fukuoka City.
There are 115 hospitals, 1526 clinics (whichinclude 75 medical malls) and 1013 dentalclinics, carried out by the Fukuoka City
government in August 2018.
The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City

2METHODOLOGY |RESEARCH OBJECT
The medical malls are divided into 3 types, village-type,building-type and attachment-type according to theSpatial combination.
TypeDefinition

Village-type

Multiple single-family clinics gather on individualsite

Building-type

Various clinics occupy the whole small building

Attached-type

Several clinics occupy one floor of an office orcommercial building

Village-Type

Tsukiguma Medical Mall

Building-Type

Imafuku Tsurumi Medical Mall

Attachment-Type

Medical Mall Toyosu
The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City

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METHODOLOGY |RESEARCH OBJECT

Clinics（1526)

Village-Type（30)Mainly located in the suburban area.
The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City

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METHODOLOGY |RESEARCH OBJECT

Building-Type（33）Located in whole area.

Attachment-Type（12)Mainly located in the central city.
The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City

2METHODOLOGY |METHOD
Data Envelopment Analysis （DEA）
DEA is the method to estimate productivity without parameter estimation based on the statistical way.
Also, DEA is an effective method for evaluating the efficiency, and it was used in much previous literature inparticular about medical facility.

<CCRo> Objective function: max𝜃=𝑢$ 𝑦$𝑣' 𝑥'$ + 𝑣* 𝑥*$ = 𝑦$𝑢$ 𝑦$ ≦ 𝑣' 𝑥'- + 𝑣. 𝑥.- (𝑗 = 1, … , 𝑛)𝑣' , 𝑣* ≧ 0𝑢$ ≧ 0
𝜃 : medical efficiency
yo : the average number of patient per day
uo : the coefficient of variable capacitance of yo
x1o : the sum of the number of first medical worker.
x2o : the sum of the number of second medical worker
The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City

2METHODOLOGY |METHOD
CCR Model

The CCR model is a more general form oflinear programming for evaluating efficiency.
We use “R” as the calculating software.

<CCRo> Objective function: max𝜃=𝑢$ 𝑦$𝑣' 𝑥'$ + 𝑣* 𝑥*$ = 𝑦$𝑢$ 𝑦$ ≦ 𝑣' 𝑥'- + 𝑣. 𝑥.- (𝑗 = 1, … , 𝑛)𝑣' , 𝑣* ≧ 0𝑢$ ≧ 0
The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City

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MEDICAL EFFICIENCY ANALYSE
Database

Input Factor①First medical worker
Doctor, Pharmacist, Part-time Doctor

Doctor

Part-time Doctor②Second medical worker
Nurse, Physical Therapist, Other Sub-medicalworker
Output Factor
Patients

×0.37
66.7h/week

24.5h/week

we correct weighting the number of part-time
doctors with 0.37 times, and then add up it with thenumber of official doctors and pharmacists.

The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City

3MEDICAL EFFICIENCY ANALYSE
Overall Result

Village type > building type > attachment type > clinic

Each Medical Treatment Subject
Otorhinolaryngology > Pediatric > Dermatology > Ophthalmology > General Surgery >Psychiatry > Internal Medicine > Obstetrics and Gynecology

The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City3

MEDICAL EFFICIENCY ANALYSE
Comparison between the Medical Mall and ICA Clinic

ICA Clinic：clinics in medical mall catchment area
Catchment area：500m walking distance ---10 minutes’
walk for the elderly, children or the sick

ICA Clinic

Catchment Area of All Medical Malls

ICA Clinic around the Village-Type MM

Medical Mall
500M

Catchment Area and ICA Clinic

ICA Clinic around the Building-Type MM

ICA Clinic around the Attachment-Type MM

The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City3

MEDICAL EFFICIENCY ANALYSE
Comparison between the Medical Mall and ICA Clinic

Medical Efficiency of ICA Clinic by Each Medical Facility
Type and Medical Treatment Subject

Catchment Area of All Medical Malls

ICA Clinic around the Village-Type MM

The Comparison of the value of medical efficiency
between the medical mall and ICA clinic
Type of medical mall

ICA Clinic < Medical mall

ICA Clinic > Medical mall

Village-type

35

5

Building-type

60

41

Attached-type

65

68

ICA Clinic around the Building-Type MM

ICA Clinic around the Attachment-Type MM

The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City

3MEDICAL EFFICIENCY ANALYSECONCLUSIONü The results show that medical malls have a tendency to have higher medical efficiency thanclinics. In particular, the village-type is an efficient medical facility.
ü The medical efficiency is different for different medical treatment subject. Even in this analysis,
the village-type showed the highest medical efficiency in many medical treatment subjects,
comparing other medical mall types.
ü In comparing the medical unit and the ICA clinic of a single medical treatment subject, thevillage-type shows higher medical efficiency in almost all of the medical treatment subjects.
The building-type and the attachment-type have slightly higher medical efficiency than the ICAclinic.

The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City

4LOCATION TENDENCY
5 Factors which described the location environment

Building Function Factors

Demographic and Socioeconomic Environment Factor

11 types of building use :residence, office, commerce,industry, medical care, government, education,accommodation, storage, agricultural forestry industries
and fisheries.

Population (divided into 3 groups: young, adult and elderly
the proportion of the upper 75 years
the proportion of working people

Transit-Related Factors

Land Price

Data about the number of bus stops and railway stationsin the medical catchment area, and the distance from thebus stop and the railway station.
Parking lot and the number of car lanes in front of thefacility

Unit: yen per square meter.

The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City

4LOCATION TENDENCY
5 Factors which described the location environment
Land use zone in Fukuoka

The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City4LOCATION TENDENCY
Location environment characters
Building-TypeLocation
As is clear from the distribution of each medical malltype, there is the tendency that village-types are locatedin the suburban area, and attachment --types are locatedin the urbanized area, and building-types are located in
the whole city.

Almost all factors show between that of village-type andattached-type. The only remarkable index is about busaccessibility. It is considered that the bus is significant
public transportation for this area.

Village-TypeAttachment-Type

The population is small and the number of the floor ofbuildings located in the surroundings is not high. The
accessibility of public transportation and the private car
is not substantial. The number of the parking lot
enough for the patient to visit by car than the other twotypes. Also, the land price is the cheapest. From theabove, the location of the village type is adequate forcommunity-based medical care.

It is more specialized for commerce and office, as is clear
from the location distribution. In addition, this area hasrich accessibility by public transportation and car,especially by the railway, compared with the other types.
Also, many people live in surround, and the proportion ofworking people is higher than that of the other types.
Furthermore, the land price is highest.

The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City

4LOCATION TENDENCY
Relationship between Medical Efficiency and Location Condition

Village-Type

Building-Type

Attachment-Type

Parking lots
The number of car lanes

High medical demand area（not obvious）

Accessibility to public transportationhigh land pricePrivate CarReputation

Public Transportation
Shopping or Working

The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka City5CONCLUSION

ü Medical mall is a new medical facility and can be divided into 3 types according to the spatial
form in Fukuoka city, which are Village-Type, Building-Type and Attachment-Type.
ü Medical malls have higher medical efficiency than clinics by using CCR model of DEA, amethod to calculate the efficiency of facilities.
ü Different medical mall type has different location tendency (building function factor, transitrelated factor, demographic and socioeconomic environment factor, the land price, and land usezone). The medical efficiency of the medical mall is also related to the location tendency.

The Analysis of Medical Efficiency and Location Tendency of the Medical Mall in Fukuoka CityTHANKS