MeshScope-Region: Distribution, Road-Network Accessibility, and Nine-Year Evolution of ICU and HCU Capacity Across Japan's 330 Secondary Medical Areas

Background: In Japan, health planning is organized around secondary medical areas (SMAs; niji-iryo-ken; 330 areas in the 2025 classification), yet nationwide analyses of intensive care unit (ICU) capacity have been conducted mainly at the prefecture level, and a recent SMA-level study addressed only the presence or absence of ICUs. The full supply structure of intensive and intermediate critical care - ICU and high care unit (HCU) beds - has not been characterized at the SMA level with respect to its composition, road-network accessibility, and evolution over time. Methods: We developed MeshScope-Region, an analytical platform built on the Hospital Bed Function Reports (byosho-kino-hokoku) for fiscal years 2016-2024, in which ICU and HCU beds were identified from notified reimbursement categories and aggregated to SMAs. Three analytical layers were integrated: (1) cross-sectional distribution of ICU/HCU beds; (2) nationwide road-network accessibility computed with the Open Source Routing Machine (OSRM) from 176,962 populated 1-km census grid cells to all facilities reporting ICU or HCU beds; and (3) a nine-year longitudinal analysis of supply-structure types, classified by k-means (k = 6) in an 8-dimensional PCA space anchored to fiscal year 2024, with earlier years projected into the same space. Results: In fiscal year 2024, 20,631 ICU/HCU beds were reported nationally (7,114 ICU-type; 13,517 HCU-type) at 1,044 facilities. Zone-level totals among SMAs with any beds ranged 229-fold (3-688 beds); the 90th/10th percentile ratio of per-capita density was 3.6. In total, 90.1% of the population resided within 30 minutes' drive of a facility with ICU beds and 97.8% within 60 minutes; only 0.8% resided beyond 90 minutes. Although 140 of the 330 SMAs had no ICU facility within their own boundaries, 84.7% of their residents could reach an ICU facility in an adjacent area within 60 minutes' drive. Longitudinally, supply structures were highly persistent: 63.0% of SMAs (208/330) retained the same structural type across all nine years, adjacent-year rank correlations of a supply-vulnerability index were 0.887-0.924 (2016 vs. 2024: rho = 0.711), and the number of SMAs with zero ICU beds remained frozen at 133-141. The Gini coefficient of bed distribution declined from 0.384 to 0.262 - although computed on ICU-type beds alone it remained 0.365 in fiscal year 2024 - and capacity growth (total +27.9%) was driven predominantly by HCU beds (+41.6%) while ICU beds grew only +8.0%. Conclusions: Japan's critical care supply structure is regionally rigid, with a stable set of approximately 140 SMAs lacking ICU beds for nearly a decade, yet road-network accessibility substantially mitigates the consequences of zone-level absence. Recent capacity growth - and much of the apparent equalization - has occurred predominantly in intermediate care. MeshScope-Region provides a standing, reproducible evidence base at the geographic unit of Japan's medical planning cycles.