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Purpose A collapse in regional healthcare through the maldistribution of physicians has been a long-debated issue in Japan and amidst this situation, a new system of board certification was initiated. The Japan Surgical Society (JSS) conducted a nation-wide survey to grasp the current distribution of surgeons in Japan, and their roles. Methods All 1976 JSS-certified teaching hospitals were invited to respond to a web-based questionnaire. The responses were analyzed to seek a solution to the current issues. Results Responses to the questionnaire were received from 1335 hospitals. The surgical departments of medical universities serve as an internal labor market and were the source of surgeons for most hospitals. More than 50% of teaching hospitals throughout the country claimed a shortage of surgeons even in well-populated prefectures such as Tokyo and Osaka. Hospitals rely on surgeons to cover the deficits in medical oncology, anesthesiology, and emergency medicine. These additional responsibilities were identified as significant predictors of a shortage of surgeons. Conclusions Surgeon shortage is a serious issue throughout Japan. Given the limited number of surgeons and surgical trainees, hospitals should make every effort to recruit specialists in the additional fields where surgeons are filling the gaps and allow surgeons to engage more in surgery.

Background/Objectives: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, with the Asia-Pacific (APAC) region bearing a disproportionate burden. This paper examines HCC challenges within seven APAC health systems, identifies key barriers at each stage of the patient journey, and proposes tailored, actionable solutions. To effectively address HCC challenges, a stepwise approach should prioritise high-impact solutions, focusing on prevention, early diagnosis, and expanding surveillance to maximise health outcomes and economic benefits, while tailoring strategies to each health system’s unique resources and constraints. Methods: A mixed-methods approach was used, including expert consultations from the 2024 HCC APAC Policy Forum, a literature review, and a review of Japan’s HCC management model. Data were collected through workshops and stakeholder feedback from healthcare professionals, policymakers, researchers and patient advocates across Australia, India, Malaysia, South Korea, Taiwan, Thailand, and Vietnam. Results: Key findings include significant disparities in HCC awareness, prevention, early detection, diagnosis, and access to treatment. Common challenges across APAC include limited public awareness, suboptimal surveillance infrastructure, and financial barriers to care. The integration of novel biomarkers and advanced surveillance modalities were identified as crucial priorities for improving early detection. Japan’s multi-faceted approach to HCC management serves as a successful model for the region. Conclusions: A customised and targeted approach is essential for reducing the HCC burden across APAC. The proposed recommendations, tailored to each health system’s needs, can significantly improve patient outcomes and reduce healthcare costs. Effective collaboration among stakeholders is necessary to drive these changes.

Introduction People living with Parkinson’s disease in regional Australia face significant challenges accessing specialized healthcare. Of all the people living with Parkinson’s disease, 40% of them are located regionally and 5%–8% of that cohort are living in aged care. Although several studies have been conducted, there is limited knowledge about their experiences as they navigate healthcare systems in regional settings. The aim of this study, therefore, is to explore the experiences of people with Parkinson’s disease and their caregivers to gain insight into their preferences for specialized Parkinson’s disease care. Design A qualitative descriptive study was conducted in a regional area of Australia. A secondary analysis of previously collected qualitative data was conducted. Methods Participants had a confirmed diagnosis of idiopathic Parkinson’s disease, resided in regional areas, and attended one clinic appointment independently or with a caregiver. They were all English‐speaking, were capable of participating in Parkinson’s disease‐specific assessment(s), and had a stable anti‐Parkinson’s disease medication regimen. Semistructured individual telephone interviews were completed. Inductive content analysis was used to analyse the interview data. Results Three main categories were identified as “accessing local specialised PD healthcare is impossible,” “mandatory travel for PD care is challenging,” and “a desire for specialist PD nurses.” Conclusions The study explored the inequities in healthcare experienced by people with Parkinson’s disease and their caregivers living regionally. People living with Parkinson’s disease or caregivers cannot access specialized Parkinson’s disease management locally, forcing them to travel for their healthcare, which proved to be challenging. Lastly, in the absence of specialist healthcare, local Parkinson’s disease nurses were their preferred clinician. Regional healthcare services must consider the inclusion of specialist Parkinson’s disease nurses.

General practitioners (GPs) played a vital role during the COVID-19 pandemic. Little is known about GPs’ view of their role, leadership, participation in regional services and preferences for future pandemic preparedness. This representative study of German GPs comprised a web-based survey and computer-assisted telephone interviewing (CATI). It addressed GPs’ satisfaction with their role, self-perceived leadership (validated C-LEAD scale), participation in newly established health services, and preferences for future pandemic preparedness (net promotor score; NPS; range −100 to +100%). Statistical analyses were conducted using Spearman’s correlation and Kruskal–Wallis tests. In total, 630 GPs completed the questionnaire and 102 GPs the CATI. In addition to their practice duties, most GPs (72.5%) participated in at least one regional health service, mainly vaccination centres/teams (52.7%). Self-perceived leadership was high with a C-LEAD score of 47.4 (max. 63; SD ± 8.5). Overall, 58.8% were not satisfied with their role which correlated with the feeling of being left alone (r = −0.349, p < 0.001). 77.5 % of respondents believed that political leaders underestimated GPs’ potential contribution to pandemic control. Regarding regional pandemic services, GPs preferred COVID-19 focus practices (NPS +43.7) over diagnostic centres (NPS −31). Many GPs, though highly engaged regionally, were dissatisfied with their role but had clear preferences for future regional services. Future pandemic planning should integrate GPs’ perspectives.

Background This study aims to analyze the demand and supply of these professionals within healthcare institutions at the county level after the Chinese government launched a three-year vocational education program of preventive medicine in 2016. Methods A national cross-sectional design and multistage cluster sampling method were employed for this study. At the county level, a total of 132 Centers for Disease Control and Prevention (CDCs), 346 medical institutions, 20 medical colleges and 1,083 graduate students were selected. Self-designed questionnaires were used to assess the demand and supply of these professionals. Descriptive statistics were applied to describe key data features. Results The county-level CDCs and medical institutions required an average annual total of 15,007 preventive medicine professionals. However, vocational colleges have only enrolled 2,025 of these students per year. Moreover, approximately two-thirds of the provinces continued to face significant demand for preventive medicine professionals, Additionally, medical institutions prioritized clinical skills while the CDCs emphasized preventive expertise as essential qualities for preventive medicine professionals. The requirement for personal qualities were consistently of the utmost importance in healthcare institutions. Furthermore, the self-assessments conducted among graduate students in medical institutions have revealed a relative insufficiency of their professional skills. Conclusions There was a general shortage of professionals in vocational preventive medicine education in China; however, certain provinces exhibited a surplus supply relative to demand, and prospective graduates primarily secure employment within medical institutions. The enhancement and refinement of professional skills are imperative in order to align with the specific demands of the preventive medicine position.

Background: One of the most noticeable integrated care-related policies in China is the growth and proliferation of County-level Integrated Health Organizations (CIHOs), which take over a set of primary healthcare institutions to form an integrated delivery network in order to achieve an ordered hierarchical delivery system by strengthening primary care.Objectives: This paper presents emerging findings from an ongoing evaluation of the early impacts of the demonstrator site, Deqing CIHO, in Zhejiang Province, in order to examine the extent to which the implementation has achieved its core objectives: (1) establishing the hierarchical referral system, (2) capacity building of primary healthcare providers, and (3) reducing the costs.Design: This case study was conducted to determine institutional and managerial processes.Settings: Data were collected and analyzed at the CIHO and county level. A structured questionnaire was used for data collection.Primary and secondary outcome measures: Indicators were selected from the existing database of the county health system and arranged into three segments to assess (1) service utilization among each level of care; (2) capacity-building progress for primary care centers, (3) cost-related indicators for both levels of care.Results: Service utilization data show that one year after CIHO implementation, the proportion of patients who chose to get inpatient care outside of the county decreased from 27.3% to 24.5%. Hospital admissions were retrieved from outside the county, while service volume slightly shifted from hospitals to primary care sites. Capacity-building indicators for township health centers show that 6 out of 12 items showed better performance compared to the national average growth rate, and a moderated growth rate appeared in terms of per capita cost.Conclusion: Progress evaluation results from Deqing CIHO indicated some positive effects on three main outcomes, which reveal the potential of CIHOs in not only strengthening primary care but also controlling cost as a result of early implementation. Further emphases of evaluation are required to determine the impacts on the quality and experience of care that are estimated using claim-based data at the individual level.

During the waves of the COVID-19 pandemic, both national and/or territorial healthcare systems have been severely stressed in many countries. The availability (and complexity) of data requires proper comparisons for understanding differences in the performance of health services. With this aim, we propose a methodological approach to compare the performance of the Italian healthcare system at the territorial level, i.e., considering NUTS 2 regions. Our approach consists of three steps: the choice of a distance measure between available time series, the application of weighted multidimensional scaling (wMDS) based on this distance, and, finally, a cluster analysis on the MDS coordinates. We separately consider daily time series regarding the deceased, intensive care units, and ordinary hospitalizations of patients affected by COVID-19. The proposed procedure identifies four clusters apart from two outlier regions. Changes between the waves at a regional level emerge from the main results, allowing the pressure on territorial health services to be mapped between 2020 and 2022.

Implementing digital health transition is challenging. Whilst technology progresses rapidly, the appropriation of innovation in healthcare is slower and has to deal with the local context. This is the case with Piedmont, an Italian region where in the last decade a number of telemedicine projects have been launched. In order to assess their implementation a survey has been recently conducted by the regional Health Department. This work builds upon the results of this investigation. The conceptual approach underlying the survey is illustrated and the main findings of the investigation discussed. To examine the regional situation, a notion of telemedicine maturity model is used. By making it explicit the main dimensions entailed in developing an ehealth service, its application can facilitate the digital health transition in the region. A core argument is that to handle the complexity of ehealth projects a collaborative environment for exchanging health knowledge should be implemented.

The coronavirus disease (Covid-19) crisis presents as human, social and economic challenges. The advent of Covid-19, unfortunate as it is, has highlighted the need for close medical cooperation between states. Medical cooperation is the key counter to fight against the Covid-19 pandemic.

Introduction Cancers around the eye are often treated using orthovoltage machines or by plastic surgery, neither of which are widely available in regional Australia. External beam radiation therapy (EBRT) using electrons and an internal eye shield is an alternative, relatively underreported technique which can provide similar cosmetic and functional outcomes. This report aimed to describe the process for the use of internal eye shields at GenesisCare Fraser Coast Radiation Oncology (GCFCRO) and the associated clinical outcomes and patient perceptions of the delivery and results of this procedure. Methods This project was conducted in two phases. Phase I was an audit of the departmental technique and short‐term clinical outcomes of 17 patients who received EBRT for skin cancer near the eyes at GCFCRO in partnership with Wide Bay Hospital and Health Service (WBHHS). Phase II was a survey of nine of those patients to elicit the patient perspective of the delivery and long‐term outcomes of the treatment. Results Phase I revealed the departmental procedures for simulation, planning and treatment at GCFCRO are consistent with other departments published protocols. Phase II results detailed positive patient perspectives regarding cosmetic outcomes and receipt of EBRT for skin cancer near their eyes. Conclusion EBRT with an internal eye shield is an acceptable alternative modality to surgery for squamous cell carcinomas (SCC) and basal cell carcinomas (BCC) around the eye in the definitive and adjuvant setting. This is particularly important in regional locations to facilitate patients receiving high‐quality care and outcomes locally. External beam radiation therapy using electrons and an internal eye shield is an alternative, relatively underreported technique which can provide similar cosmetic and functional outcomes. This report aimed to describe the process for the use of internal eye shields and the associated clinical outcomes and patient perceptions of the delivery and results of this procedure.