市町村における母子保健の事業形態と地域特性との関係に関する研究—事業の直営，民間委託の別に着目して

A Study on the Relationship Between the Types of Maternal and Child Health Care Services in Municipalities and the Regional Characteristics of These Municipalities: Focusing on Whether Services Are Directly Managed or Outsourced to the Private Sector

要旨

　目的：市町村の母子保健の事業形態について直営・民間委託の別に着目し，地域特性ごとの民間委託の状況を明らかにすることである．

　方法：人口を基準に財政指数，出生率で層化階層化し抽出した400市町村の母子保健業務担当管理者を対象とした記名自記式質問紙調査の結果と，全国1,741の市町村について地域特性を示す18項目でクラスター分析により類型化した結果を突合させ，特徴を分析した．

　結果：クラスター分析は，「大都市型」「合併無面積小自治体型」「合併有面積大自治体型」「超高齢町村型」「超小規模分散居住町村型」に類型化できた．質問紙調査の113（有効回答率28.3％）を各クラスターと突合した結果，民間委託の割合は「大都市型」および「合併有面積大自治体型」で他と比較して高かった．また，地域特性により理由の背景が異なっていた．

　結論：自治体の保健事業の直営・民間委託は，将来も見据え，地域特性を踏まえて検討する必要がある．

　Objective: The purpose of this study is to examine the operational structure of maternal and health care services in Japanese municipalities, focusing on the distinction between direct management and private outsourcing, and to clarify the status and background of outsourcing for each regional characteristic.

　Methods: The results of a self-administered questionnaire survey targeting managers responsible for maternal and child health services in 400 cities, towns, and villages were stratified by fiscal index and birth rate based on population. These results were then compared with the results of a cluster analysis classifying 1,741 cities, towns, and villages nationwide into types based on 18 items indicating regional characteristics, which allowed for the analysis of distinctive features in the data.

　Results: The cluster analysis was able to categorize the municipalities into "large city", "small municipality without merger", "large municipality with merger", "very old town/village", and "very small, dispersed residential town/village". The results of the questionnaire survey(113 valid responses, 28.3%) were compared with those of each cluster, and the percentage of outsourcing to the private sector was higher in the "large city" and "large municipality with merger" groups than in the others. Furthermore, the background of the reasons differed depending on regional characteristics.

　Conclusion: When planning health services, local governments need to consider whether to directly manage or outsource to the private sector so that services can be provided in a sustainable manner, with an eye to the future and taking regional characteristics into consideration.