Association between hospital bed attainment rates and the density of healthcare professionals in Japan: A nationwide ecological study

This is the authors' abstract. We don't add key points for this paper.

Background: In Japan, the "Regional Healthcare Plan" aims to optimize the allocation of hospital beds based on projected healthcare demand. However, many regions fail to achieve the recommended bed attainment rates, suggesting that factors beyond demand, particularly healthcare workforce supply, may influence regional disparities. This study examined the association between hospital bed attainment rates and the density of multidisciplinary healthcare professionals across Japan. Methods: We conducted a nationwide cross-sectional ecological study using publicly available data from the 2023 Community Health Care Visions and 2023 Medical Facility Survey. The unit of analysis was the secondary medical field. Hospital bed attainment rates were calculated as the ratio of actual to required beds and were categorized into three groups (<90%, 90-110%, and > 110%) for each bed function (intensive care, acute care, inpatient rehabilitation, and chronic care). The healthcare workforce density (per 100,000 people) was calculated for multiple professions. Group comparisons were performed using the Kruskal-Wallis test with Bonferroni correction, and associations were assessed using Spearman's rank correlation coefficients. Results: Bed attainment rates varied widely across regions, with only a minority meeting the recommended range, particularly for intensive and acute care beds. The association between bed attainment rates and workforce density differed according to bed function. High total bed attainment rates were associated with a high density of nonphysician professionals, including nurses and rehabilitation staff. Intensive care bed attainment rates were positively associated with physicians and pharmacists. By contrast, acute care bed attainment rates were negatively correlated with physician and pharmacist densities. Inpatient rehabilitation and chronic care bed attainment rates were positively associated with the density of multiple nonphysician professionals, such as therapists, dietitians, and care workers. Conclusion: The relation between hospital bed attainment rates and healthcare workforce density varies substantially according to bed function. These findings suggest that effective regional healthcare planning should incorporate not only projected demand but also the composition and distribution of the healthcare workforce to avoid mismatches between bed capacity and service delivery.