OBJECTIVES: Japan is considering policies to set the target health expenditure level for each region, a policy approach that has been considered in many other countries. The objective of this study was to examine the relationship between regional health expenditure and health outcomes after out-of-hospital @entity1167 (OHCA), which incorporates the qualities of prehospital, in-hospital and posthospital care systems. DESIGN: We examined the association between prefecture-level per capita health expenditure and @entity1 ' health outcomes after OHCA. SETTING: We used a nationwide, population-based registry system of OHCAs that captured all cases with OHCA resuscitated by emergency responders in Japan from 2005 to 2011. @entity1 : All @entity1 with OHCA aged 1-100 years were analysed. OUTCOME MEASURES: The @entity1 ' 1-month survival rate, and favourable neurological outcome (defined as cerebral performance category 1-2) at 1-month. RESULTS: Among 618,154 cases with OHCA, the risk-adjusted 1-month survival rate varied from 3.3% (95% CI 2.9% to 3.7%) to 8.4% (95% CI 7.7% to 9.1%) across prefectures. The risk-adjusted probabilities of favourable neurological outcome ranged from 1.6% (95% CI 1.4% to 1.9%) to 3.7% (95% CI 3.4% to 3.9%). Compared with prefectures with lowest tertile health expenditure, 1-month survival rate was significantly higher in medium-spending (adjusted OR 1.31, 95% CI 1.03 to 1.66, p=0.03) and high-spending prefectures (adjusted OR 1.30, 95% CI 1.03 to 1.64, p=0.02), after adjusting for @entity1 characteristics. There was no difference in the survival between medium-spending and high-spending regions. We observed similar patterns for favourable neurological outcome. Additional adjustment for regional per capita income did not affect our overall findings. CONCLUSIONS: We observed a wide variation in the health outcomes after OHCA across regions. Low-spending regions had significantly worse health outcomes compared with medium-spending or high-spending regions, but no difference was observed between medium-spending and high-spending regions. Our findings suggest that focusing on the median spending may be the optimum that allows for saving money without compromising @entity1 outcomes.

Regional health expenditure and health outcomes after out-of-hospital XXXX in Japan: an observational study.

@entity1 :: ('9606', 'Species') :: ['PARTICIPANTS', 'patients', 'patient'] @entity1167 :: ('MESH:D006323', 'Disease') :: ['cardiac arrest']
@entity1167 :: (MESH:D006323,Disease) :: ['cardiac arrest']
