What sort of medical care is ideal? Differences in thoughts on medical care among residents of urban and rural/remote Japanese communities

Studies of aspirational ideals of medicalcare generally focus on patients rather than on ordinary people receiving or not receiving medicationsat the time of interview. The literature has not accurately conveyed the distinct ideals in individual communities or undertaken inter-regional comparisons. This current qualitative study focused on ideal medicalcare as perceived by residents of distinct Japanese communities in their everyday lives. Between December 2011 and November 2012, one-on-one and group-based semi-structured interviews were conducted with 105 individuals, each of whom had continuously lived for 20 years or more in one of the four types of communities classified as either ‘metropolitan area’, ‘provincial city’, ‘mountain/fishing village’ or ‘remote island’ in Japan. Interviews were transcribed from digital audiorecordings and then analysed (in tandem with non-verbal data including participants’ appearances, attitudes and interview atmospheres) using constructivist grounded theory, in which we could get the voice and mind of the participant concerning ideal medicalcare. The common themes observed among the four community types included ‘peace of mind because of the availability of medicalcare’ and ‘trust in medicalprofessionals’. Themes that were characteristic of urban communities were the tendency to focus on the content of medicalcare, including ‘high-level medicalcare’, ‘elimination of unnecessary medicalcare’ and ‘faster, cheaper medicalcare’, whereas those that were characteristic of rural communities were the tendency to focus on lifestyle-oriented medicalcare such as ‘support for local lifestyles’, ‘locally appropriate standards of medicalcare’ and ‘being free from dependence on medicalcare’. The sense of ideal medical carein urban communitiestended to centre around the satisfaction with the content of medicalcare, whereas that in rural communities tended to centre around the ability to lead a secure life. By considering medicalcare from the geographical point of view, we found out the significant relationship between communities and perceptions of medicalcare ideals.