The association between health care spending and quality of care for stroke patients in Japan

Jason Lee, Toshitaka Morishima, Sungchul Park, Tetsuya Otsubo, Hiroshi Ikai, Yuichi Imanaka

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: To elucidate the association between health care spending and the quality of care in ischaemic stroke patients in Kyoto prefecture, Japan. Methods: Municipalities in Kyoto were categorized into quartiles based on age-sex adjusted spending for ischaemic stroke admissions.We used logistic regression models to analyse if patients from lower spending municipalities were less likely to obtain high-quality care. The sample consisted of patients admitted to hospitals in Kyoto prefecture due to ischaemic stroke between February 2009 and March 2010. Quality measures included process indicators such as diagnostic tests, recommended medications, and rehabilitation services; and outcome measures of in-hospital mortality and 30-day mortality rates. Results: Mean health care spending per patient ranged from 9749 US dollars (USD) to USD 14,303 from the lowest to highest municipalities. Patients from municipalities in the lowest spending quartile were significantly associated with poorer performance in the majority of the process indicators but had similar mortality rates to patients from high-spending municipalities. Conclusions: Spending was found to be unevenly associated with the quality of care provided and may be indicative of an insufficient provision of resources and specialist expertise in the lower spending municipalities. Further efforts must be made to improve the quality of care in lower spending regions in Japan.

Original languageEnglish
Pages (from-to)77-82
Number of pages6
JournalJournal of Health Services Research and Policy
Issue number2
StatePublished - Apr 2013

Bibliographical note

Funding Information:
This work was supported in part by a Health Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan (grant number H22-seisaku-ippan-028) and a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (grant number Kiban-A-22249015). The funding sources had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.


  • Health expenditure
  • Quality of health care
  • Stroke


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