In a society aging as fast as Japan’s, a solid medical infrastructure is a minimum precondition for viability. Japan’s medical infrastructure is anything but solid, warns Shukan Jitsuwa (Oct 8).
From January to August this year, it says, no fewer than 40 hospitals went bankrupt, nearly double the 21 that failed during the first eight months of last year.
Japanese medical care still ranks among the best in the world, but can that last? In 1990, according to health ministry statistics, there were 10,096 medical facilities across the country; the current figure is 8,749.
At one time, Shukan Jitsuwa claims, if a hospital went bankrupt it was a sure sign of bad management. That may no longer be true. Hospitals today seem to operate with the deck stacked against them.
More work for less pay is the heart of the matter. Cost-cutting reforms by former Prime Minister Junichiro Koizumi led to lower fees for doctors and, as a result, fewer young people choosing medicine as a career. That, together with a surging number of patients as the nation ages, has created a situation whose most appalling symbols have been emergency patients dying in transit, turned away by hospitals strained beyond capacity.
As of 2007, 626 of Japan’s 982 public hospitals were operating in the red, Shukan Jitsuwa finds. Fewer doctors mean fewer patients and less income. Japan has two doctors per 1000 population, ranking 27th among the 30 OECD nations.
Possibly foreshadowing worse to come nationwide was the closure last May of Choshi General Hospital in Choshi, Chiba Prefecture. The hospital was severely short of doctors, and the town’s mayor, after pledging in his election campaign to keep the hospital open, ordered the shutdown, claiming to have under-estimated its plight. Angry residents demanded a recall, and got it -- only to go on to elect the deposed mayor’s predecessor, whose policies some blame for the hospital’s being in trouble in the first place. Its fate continues to hang in the balance.
Some good may come of all this yet. Shukan Jitsuwa mentions two hospitals in Sakata, Yamagata Prefecture, that finally merged last year after years of “stealing each others’ patients” and driving each other to the brink of collapse.
Another hopeful sign is the toll-free expressway policy announced by Prime Minister Yukio Hatoyama. The improved access this implies, Shukan Jitsuwa believes, could inject fresh life into hospitals in comparatively remote areas.
That won’t be enough, of course, to turn the situation around. Policies will have to be devised to deal with the chronic doctor shortage, and hospitals will need to be reorganized to meet the new kind of society -- much older than any ever known to human history -- now taking shape. As the magazine points out, the pension mess is not the only weighty issue filling, and threatening to shatter, the health ministry’s plate.© Japan Today