Medical Facility Location and Urban Planning

本研究以日本六个大都会地区的精神科诊所的区位特征为例，探讨土地用途管制对精神科诊所的影响，以反映近期医疗服务的变化。精神科临床是从以下三个角度来研究的。L)作为政府对医疗服务提供控制的政策变化的一个例子，2)作为有害设施周围区位冲突的一个例子，3)作为一个在精神压力重重的当代社会中不可或缺的设施。邮寄调查是对东京、横滨、名古屋、京都、大阪和神户六个最大的大都市地区的精神科诊所进行的。调查结果总结如下：1)在1980年前后，新开设的精神科诊所大幅增加，这是因为公众反对精神病院提供的护理质量，以及医疗保险制度的变化。2)新开设的精神科诊所往往设在较大的大都市地区，特别是在铁路终点站附近。这是因为人们经常认为这些诊所是有害的设施。从1985年开始，更多的精神科诊所设在航站楼周围。这是精神科诊所首选的地点，原因如下。I)患者更喜欢隐蔽的环境。(Ii)铁路终点站可以方便地从更广泛的区域进出外城。iii)在铁路终点站周围的商业区，可以避免区位冲突，因为城市规划对土地用途的控制没有郊区住宅区那么严格。在提供精神治疗服务方面的这种空间不平等与最近非制度化的政策取向不符。

In this research project, the location characteristics of psychiatric clinics in six metropolitan areas in Japan is investigated as an example of recent change in medical service provision, focusing on the effect of land use control upon them. Psychiatric clinics are studied from the following three viewpoints. l)As an example of change in policy change in government control on medical service provision, 2)as an example of locational conflict around noxious facility 3)as an indispensable facility in the contemporary society with many mental stresses. Mail survey are conducted to the psychiatric clinics in largest six metropolitan areas, i.e. Tokyo, Yokohama, Nagoya, Kyoto, Osaka, and Kobe. The findings are summarized as blow.1)After around 1980, newly opened psychiatric clinics have increased greatly Such increase is prompted by the public opposition against the quality of care provided at the psychiatric hospitals, and by the change in medical insurance system.2)Newly opened psychiatric clinics tend to locate in larger metropolitan areas, especially in the vicinity of railway terminal station. This is because people often regard these clinics as noxious facilities.3)From 1985, more psychiatric clinics are located around the terminal. The reasons why such location is preferred for psychiatric clinics are as follows. i) Patients prefer anonymous surroundings. ii) Railway terminal has easy access from the wider areas from in and out of the outer city iii) Locational conflicts can be avoided in the commercial areas around the railway terminal where land use control by urban planning is less strict than in the suburban residential areas. Such spatial inequality in the provision of psychiatric treatment service is not compatible with the recent policy orientation towards deinstitutionalization.