Strategies for improving pediatric services in Japan.

The shortage of pediatricians and emergency medical care for children is an issue of great concern in Japan. This study attempts to identify the problems in children's medical care and their causes. With multiple secondary data sources, we found that over 80% of outpatient pediatric services were provided by clinics, that over 95% of clinics were closed on holidays, Sunday, and Saturday night, that among the children's illnesses respiratory ailments were dominant and were generally acute and required immediate treatment or consultation, and that the revenue rates from providing services for children were lower than those for adults. That fewer clinics are open on Saturday night, Sunday and holidays, and workday evenings may be the main reason why it is difficult for children to find pediatric services outside of normal working hours. Lower revenue rates may be one of the key reasons why the number and rate of clinics and hospitals providing pediatric services continue to decline, and fewer physicians are willing to provide services for children. The findings in this research would provide important information of multiple dimensions for the governments to make efforts to improve pediatric services in Japan. Our proposition is to prompt pediatric specialists and internists who can treat pediatric cases in clinics to provide pediatric service systematically and alternatively at night, and to adjust the fee-for-service scales of pediatric services.