Urban-rural differences in hospital beds and employee income: a study using the rurality index for healthcare research in Japan.

Objective: This study investigated the association between rurality and healthcare employees' income in Japan's secondary medical areas (SMAs), specifically focusing on whether hospital beds, particularly in public hospitals, contribute more to employee income in rural areas than in urban areas at the SMA level. To our knowledge, this is the first study to examine these associations using a validated rurality index for healthcare research in Japan (RIJ). Materials and Methods: This ecological cross-sectional study analyzed all the SMAs in Japan using publicly available data. SMAs were categorized into urban and rural areas using the RIJ cutoff values. Multiple linear regression analyses were conducted to examine the association between the proportion of employee income in healthcare (dependent variable) and number of hospital beds by type and ownership (explanatory variables). All variables were treated as continuous variables and the forced entry method was used. Hospital bed types included general and long-term care beds in both public and private hospitals, high-acuity hospital beds, and clinic beds per 100,000 population. Results: Of the 334 SMAs, 158 were classified as urban (low RIJ score) and 176 as rural (high RIJ score). In urban areas, general beds in private hospitals had the strongest association with healthcare employee income (β=0.396, P<0.001). In rural areas, general beds in public hospitals showed the strongest association (β=0.452, P<0.001), followed by general beds in private hospitals (β=0.342, P<0.001). Conclusion: This study demonstrated that the contribution of hospital bed type to healthcare employee income differs substantially between urban and rural areas. Rural areas depend more on general beds in public hospitals, whereas urban areas rely primarily on general beds in private hospitals. This study suggests that public hospitals, particularly their general bed numbers, play a critical role in sustaining essential healthcare services and supporting employee incomes in rural areas.