Consolidation of the perinatal care system and workload of obstetricians: an ecological study in Japan

Sanae Hattori; Nobuo Sakata; Miho Ishimaru; Nanako Tamiya

doi:10.3389/fgwh.2023.1030443

Consolidation of the perinatal care system and workload of obstetricians: an ecological study in Japan

Front Glob Womens Health. 2023 Apr 28:4:1030443. doi: 10.3389/fgwh.2023.1030443. eCollection 2023.

Authors

Sanae Hattori¹, Nobuo Sakata^{1

2}, Miho Ishimaru³, Nanako Tamiya¹

Affiliations

¹ Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
² Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
³ Department of Oral Health Promotion, Graduated School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.

Abstract

Objectives: We examined the relationship between consolidation of delivery and the workload of obstetricians working at perinatal centers.

Methods: We conducted a descriptive analysis using perinatal care areas classified into three types (metropolitan, provincial, and rural). We calculated the Herfindahl-Hirschman Index (HHI) as an index of consolidation and the proportion of the deliveries at clinics as an indicator of the low-risk deliveries and the deliveries per center obstetrician as an indicator of obstetricians' workload. We used >150 deliveries yearly as an excess indicator. The correlation between the HHI and obstetricians' workload and the proportion of deliveries at clinics was examined using the Pearson correlation coefficient.

Results: The proportion of areas with >150 deliveries yearly was higher in the consolidated areas. In provincial areas, obstetricians' workload was positively correlated with the HHI and was negatively correlated with the proportion of deliveries at clinics.

Conclusions: The obstetricians' workload may be increasing where more consolidation occurs. In provincial areas, the center obstetrician's workload could be reduced not only by consolidation but also by sharing the role of handling low-risk deliveries with clinics and hospitals with obstetric units other than perinatal centers.

Keywords: delivery; ecological study; obstetrician; perinatal care; workload.