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: