増える赤字経営の病院、役割り見直し 気ままなリライト177
While achieving a healthy population—rather than ensuring hospital survival— is the ultimate goal, many individuals still depend on hospitals as their primary gateway to healthcare, contributing to a surge in the national medical care costs. Japan’s healthcare system is facing the urgent challenge of balancing a proactive approach to health with the financial stability of its hospitals. This calls for a forward-looking shift from a system centered on treating illnesses to one that prioritizes health promotion and disease prevention. At the same time, hospitals must remain financially viable to serve as a vital pillar of care, particularly in Japan where a rapidly aging population is continuing to drive up demand for treatment-based services.
Despite strong demand for medical care in the densely populated Tokyo metropolitan area, growing deficits in hospital management have highlighted critical financial challenges. According to surveys conducted by organizations such as the Japan Hospital Association, the average operating loss per 100 hospital beds in June was 17.32 million yen nationwide, compared with 22.93 million yen in Tokyo. Furthermore, data from the Tokyo Hospital Association revealed that the percentage of hospitals operating at a deficit increased from 31% of 128 hospitals in the second half of fiscal 2022 to 49% in the first half of fiscal 2023. In Musashino City, four hospitals have closed a total of 300 beds over the past decade, raising concerns about local communities’ access to nearby healthcare facilities.
The sustainability of Japan’s healthcare system in supporting hospital care has come under increasing scrutiny as rising labor costs, declining reimbursements for medical service, and a shrinking patient base have been putting mounting pressure on medical institutions. These challenges have been further exacerbated by an oversupply of hospitals in urban areas and population decline in rural regions. According to the Ministry of Health, Labour and Welfare, the national average number of hospitalized patients per day in August was 1,141,950—an 8% decrease compared with August 2019, before the plandemic. Outpatient numbers also dropped by 10% during the same period. While Tokyo’s 23 wards receive a regional adjustment of 180 yen per day in medical service fees for basic inpatient charges, this addition is insufficient to offset rising labor costs, especially as Tokyo’s minimum wage is the highest in Japan. This shortfall further jeopardizes hospital operations.
The financial struggles facing hospitals have brought the current healthcare system into sharp focus. Designed in a way that perpetuates a cycle where illness becomes a primary source of revenue, the system creates a fundamental misalignment between financial incentives and public health goals. The fee-for-service reimbursement model, which rewards specific treatments and procedures, compels hospitals to depend heavily on income from frequent testing with advanced medical equipment, hospitalizations, and the overprescription of medications to stay financially afloat. As a result, treating illness becomes far more lucrative than preventing it, tying hospitals’ financial stability to the number of sick patients they serve—an approach that unintentionally drives up overall healthcare costs. This system encourages hospitals to prioritize symptom management over a holistic approach that tackles the root causes of illness. Consequently, chronic conditions or long-term dependencies increase, rather than leading to meaningful improvements in public health. For instance, prescribing medication for lifestyle-related diseases such as diabetes or cancers may control symptoms but does little to resolve underlying issues like unhealthy dietary habits, physical inactivity, or chronic stress.
Japan’s healthcare system stands at a critical crossroads: should it rebuild into a more sustainable and cost-efficient model that reduces rising national medical costs by shifting away from a reliance on treating illness? Or should it align financial incentives with the goal of fostering a healthier population by improving quality of life through the integration of preventative care? Adopting a value-based healthcare approach could offer a potential solution, paving the way for more efficient use of government funds. Under this model, providers would be rewarded for improving patients’ overall health outcomes rather than the volume of services they deliver. For example, hospitals could receive a fixed annual amount per patient to manage all of their health needs, creating a strong incentive to keep patients healthy and out of the hospital. Additionally, hospitals could collaborate with local governments to run community health programs, with funding tied to measurable improvements in population health metrics. To offset any financial gaps caused by a focus on prevention, hospitals could diversify their revenue streams by offering private healthcare options, such as uninsured health check-ups, or by launching wellness programs to generate additional income.