Japan, hospital-dependent as never before, is hospital-challenged as never before

It’s not just people who grow old. Buildings do too. Buildings can be rebuilt, and so can people, to some degree – in hospitals for the most part, if they’re functioning. Are Japan’s? Yes and no, with no overtaking yes slowly but surely. Medical infrastructure is crumbling, warns Josei Jishin (June 23-30).

There are – 100,000 or so medical clinics aside – some 8,300 hospitals in Japan. What’s the difference between a clinic and a hospital? Size. Hospitals have 20 or more beds, clinics fewer than 20. Here we’re dealing with hospitals, 1,568 of which, 23 percent, are 40 or more years old, according to a Yomiuri Shimbun survey published in May.

Shortage plagues and crimps necessary renovation – shortage of doctors, of building materials, of construction workers, of funds amid soaring costs, of everything except patients, whose medical needs an aging society multiplies exponentially. Over 20 million Japanese – 16.8 percent of the population – are 75 or older. Imagine describing your symptoms to a hospital receptionist and being told, “Sorry, we can’t help you, the pipes are leaking.”

Surreal, as in only too real. There were two 24-hour emergency care hospitals in the Tokyo suburb of Kichijoji. One shut down in 2024, leaving one. “We’re facing a care vacuum,” hospital governance expert Dr Masahiro Kami tells Josei Jishin. It’s not just one neighborhood, it’s nationwide. Tokyo, medically speaking, is actually relatively thriving. The Yomiuri survey (which the magazine cites) shows it ranking 14th among 47 prefectures in terms of aging facilities – the lower the rank the better.

Leading the list is Fukushima Prefecture, 34 percent of whose hospitals were built 40 or more years ago. Best off is Shizuoka (13 percent). Tokyo’s 25 percent compares favorably with Kyoto (30 percent) and Osaka (29 percent). Small comfort, if the ambulance you’re in, engine racing, siren wailing, has nowhere to go, hospital after overstrained hospital pleading insufficient or decaying resources and turning it away before it finally – if it does – find you a bed. “It can mean life or death,” says Kami, confirming the conclusion any non-expert would leap to.

The surviving Kichijoji hospital complains of staff shortage rather than decaying infrastructure, but examples of the latter are not far to seek. One is the Okamotodai psychiatric and emergency hospital in Utsunomiya, Tochigi Prefecture. “The air conditioning creaks, the pipes leak, the elevator stops,” says a prefectural medical official.

In the same city is the Tochigi Cancer Center. The same official says of it, “Pipes carrying off waste water leak. Steam seeps into the operating room. Heavy rain affects aging motors which emit smoke. Staff have to deal with all that even as they’re treating patients.” It’s black comedy. What is black comedy? It’s when you know it’s not funny but can’t help laughing. 

Universal health insurance came to Japan in 1961. It was 15 years into its postwar rebuilding. Hospitals were part of it from the beginning, a bigger part later on, and maybe too big a part in the bubble years of the 1970s and '80s. Seventy percent of Japan’s hospitals are privately owned. The boom was as much entrepreneurial as medical.

The bubble burst as bubbles do, turning assets into liabilities. Not that hospital construction outran patients’ needs. Far from it. If anything the reverse is true. But hospitals built then are 40 years old now, increasingly showing their age, increasingly needing renovation which grows increasingly costly, while medical fees remain fixed by government regulation, uniform nationwide regardless of local cost of living variations. Four hundred and seventy-eight hospitals and related facilities went bankrupt last year, the highest number ever.

There’s an irony here. Japan’s medical knowledge and medical skills are cutting-edge. Medical equipment can do things earlier ages would have called miracles. What’s the catch? The cutting-edge equipment can’t be housed in old, cramped buildings, explains a Funabashi Municipal Medical Center official wrestling with the problem. And old cramped buildings cannot be renewed without bankruptcy-inviting expenditure – which, even if available, would not help, the same official goes on to tell Josei Jishin. Bidding for reconstruction contracts was underway when “construction companies bowed out on the grounds they couldn’t do the work within the (government-set) funding limits or the required time frame.”

Is it hopeless? Maybe not, the magazine says, if major corporations can be creatively engaged in the process. To some extent they already are: JR, NTT and Toyota all run hospitals. Uniqlo and Softbank are named as possible additions to the roster. Time presses. It’s aging versus renewal, aging winning the battles. Can renewal win the war?

 Michael Hoffman is the author of the “Japan’s Lost Histories” column.

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