This study identified considerable regional disparities in home healthcare resources in Japan, with higher concentrations of (enhanced) HCSCs in urban areas compared to rural areas. Several factors likely contribute to this disparity. Urban areas have closer patient residences, making home visits more efficient, while rural areas’ scattered homes increase travel time and reduce profitability.6 Additionally, securing physicians and maintaining a 24-hour on-call system in rural areas can be challenging due to limited resources.7 Instead, general clinics may tend to conduct home visits to meet patient demand and support home healthcare in these areas. However, general clinics, primarily operated by solo-practice physicians, typically extend their outpatient services to include home healthcare.6 Therefore, they can visit only a limited number of patients and are often unable to manage complex medical requirements such as home oxygen therapy and palliative care for terminal cancer.6 Furthermore, these physicians face a heavy burden,7 which is a critical concern.

Several measures can help reduce these disparities. Implementing additional fees for enhanced HCSCs, based on population density, could incentivize home healthcare in rural areas. Promoting telemedicine systems could also reduce travel burdens for providers, improving the feasibility of rural home healthcare.

In conclusion, our findings highlight persistent regional disparities in home healthcare resources in Japan from 2014 to 2020, with significant HCSCs (especially enhanced) resource limitations in rural areas. Targeted measures are essential to address these disparities and support the aging population effectively.