ASOURCE Navi

In areas under the state of emergency, there are cases where inpatients are not accepted due to the rapid increase in the number of people infected with the new coronavirus, and there is concern about "collapse of medical care". Compared to Western countries, Japan has more beds per capita and fewer infected people, so why are the beds so tight?

According to recent data compiled by the Organization for Economic Co-operation and Development (OECD), Japan has 13.0 beds per 1,000 people, and in the seven major countries, Germany has 8.0 beds, France has 5.9 beds, Italy has 3.1 beds, and the United States has 2.9 beds. It is overwhelmingly larger than the 2.5 beds in the UK (Fig. 1). Even in the acute phase, Japan has 7.79 beds, which is more than 2.2 times higher than the average of 3.6 beds in member countries. According to 2016 data, the number of hospitals in Japan is 8,442, which is the largest number, 1.5 times that of the United States.

1st place 8,442 Japan
2nd place 5,564 USA
3rd place 4,474 Mexico
4th place 3,788 Korea
5th place 3,100 Germany
6th place 3,065 France
7th place 1,922 United Kingdom
8th place 1,510 Turkey
9th place 1,331 Australia
10th place 1,086 Italy

Figure 1 Number of beds per 1000 population Source: OECD

However, the number of beds for corona in Japan is about 28,000, which is said to be less than 4% of the total of about 730,000 beds that can deal with infectious diseases. It is said that the number of beds to be secured for the severely ill is flat at about 3,600. According to a survey by the Ministry of Health, Labor and Welfare last fall, 53% of public hospitals, 69% of public hospitals, and 14% of private hospitals have accepted new corona patients from 4,201 hospitals with acute care wards (Fig. 2).

In Europe, many hospitals are large-scale public hospitals, and it is said that they can easily reflect the intentions of the government. rice field. In addition, a system has been established in which a specific doctor is used as a family doctor. For example, Germany introduced the "family doctor system" in 2004, and France introduced the "doctor system" in 2007. Patients first see a doctor of their choice and are referred to other specialists as needed. Amid concerns about a shortage of medical staff, it is important to clarify the division of roles between family doctors for primary medical care and specialists and hospitals for secondary and subsequent medical care from the perspective of effective utilization of medical resources. It has been pointed out that in Japan as well, the introduction of a system in which a specific doctor is a family doctor, as in Europe, should be considered immediately.

It has been pointed out that the number of medical staff is not sufficient as one of the reasons why the corona beds are tight. According to OECD data, Japan has 2.5 doctors per 1,000 people, 28th out of 35 countries shown in the data, compared to Germany 4.3, France 3.4, the United Kingdom 3.0 and the United States 2.6. It is decreasing (Fig. 3). There are about 8,000 ICU specialists in Germany who have severely ill corona patients, but only nearly 2,000 in Japan.

The artificial cardiopulmonary device "ECMO" is used to treat patients with serious new coronavirus, but according to a survey by the Japanese Society of Respiratory Medicine, there are 1,400 ECMOs in Japan, even in the world. We are proud of the leading number of units owned. However, the number of clinical engineers who can operate ECMO is as small as 1000 or less, and ECMO operation needs to be operated 24 hours a day in 2 to 3 shifts, and it is estimated that about 300 people can actually work at all times. .. Furthermore, since a team of three people, a "doctor," "nurse," and "clinical engineer," is required, a large number of staff are required in addition to the clinical engineer, and there is a shortage of staff for treatment.

Dealing with corona patients is said to take twice as much effort as general patients. However, in Japan, most private hospitals, which account for about 80% of all hospitals, are small and medium-sized with 200 beds or less, have limited staff, and are not equipped with infectious disease control equipment. Originally, the number of medical staff per 1,000 people is small, and the number of staff is dispersed in small hospitals, which is one of the reasons for the tight bed.

Figure 2. Results of acceptance of new corona patients in acute care hospitals According to a survey by the Ministry of Health, Labor and Welfare as of the end of September 2020

Figure 3. International comparison of doctors per 1,000 population Source: OECD

Another background to the tight corona bed is the structural problems of the Japanese medical system. It is said that there are few vacant beds in private hospitals because it may be difficult to manage the hospital unless the beds are almost full. There are few specialists in infectious diseases, and the staff is not accustomed to infection control. Once a cluster (infected population) occurs in the hospital, the credibility of the hospital will be shaken, and in some cases, bed closure and hospitalization restrictions will be forced, which can have a huge impact on the management of the hospital. It has also been reported that accepting corona patients causes reputational damage to hospitals. In other words, accepting corona patients has a great risk of reducing hospital profits, which is different from public hospitals that maintain a deficit with tax.

Currently, regarding the problem of securing corona beds, ⓵ have small and medium-sized hospitals expand the acceptance of patients who have recovered from corona, ⓶ expand the beds of corona-compatible hospitals on a timely basis, and replace their normal medical functions with small and medium-sized hospitals. Get — etc. are being considered. The question is how to make good use of the medical resources of private hospitals and how to make the cooperation and division of functions between hospitals effective.