Covid exposes weakness to Japan’s top-tier healthcare system

Photographer: Noriko Hayashi / Bloomberg

Coronavirus infections in Japan are found in a fraction of major Western countries, although the island nation is showing growing concern that its highly valued medical system is facing an impending collapse.

While it has the liveliest citizens in the world and a plethora of hospital beds and medical equipment, reports of overwhelmed hospitals and deaths from mild quarantine infections have raised concerns. Last week, the government extended the state of emergency over Tokyo and other regions in part due to the insecurity of the health care system.

The disconnect is challenging Japan’s reputation as a nation rich in medical resources and is another source of frustration for citizens who are no longer satisfied with the country’s management of the pandemic, which has been reactive and contradictory.

Given the relatively small number of cases in Japan of about 400,000 infections, questions arise as to why the government says the medical system is under stress, a description that evokes scenes of overflowing hospitals as in most countries. affected. Meanwhile, neighbors such as South Korea and China have properly managed their recent Covid-19 waves.

At first, most hoped that Japan’s health infrastructure would meet the challenge. Its health system is in the highest decile among the 204 sites examined by the Universal health coverage index, a measure that monitors the effectiveness of 23 different aspects of a health care system.

However, as the pandemic progressed, the strengths of the system worked against it, showing how the preponderance of private hospitals was oriented. towards general and preventive care does not have the flexibility to respond quickly. Crucial weaknesses were also accentuated, such as the lack of doctors compared to the number of hospital beds.

“To make the medical system break like this, we really didn’t expect it and we need to think about it,” Health Minister Norihisa Tamura said in a Jan. 15 interview with Bloomberg. In the future, community health care programs in Japan should have a pandemic response strategy, he said.

Japan currently has about 33,000 patients in need of hospital treatment and has only suffered about 6,000 deaths from covides, a relatively low number compared to other countries.

Japan’s medical system is dominated by private hospitals that account for 70% of the country’s 8,300 institutions, which includes specialized facilities such as psychiatric and long-term care. In normal times, their business competition increases the level of service to patients. But in a public health emergency, this has resulted in a lack of coordination: the medical systems of some cities or prefectures have empty beds that can accommodate Covid patients, while others are overwhelmed.

Unlike the United States and the European Union, there has been no central coordination effort to move patients or medical staff from stressed hospitals to those with reserve capacity. In December, the medical systems in Osaka and Hokkaido were under pressure from a wave of Covid-19 patients, and the country had to send medical staff from the Self-Defense Forces to help them. Meanwhile, there were abundant unused resources in other prefectures.

Kagoshima, in southern Japan, had only two seriously ill Covid-19 patients and the intensive care unit was almost empty in early February, said Hiroyuki Morita, a medical journalist who is also a doctor at a clinic in the area.

“The Japanese health care the system does not have the flexibility to respond quickly to situations, ”he said. “Things like moving patients or reassigning staff: you can do it in Europe, but not in Japan.”

Another drawback is that Covid-19 has received a government designation that requires that all patients who test positive be hospitalized, even if they are not very ill. The rule was relaxed to allow asymptomatic and mild cases to be quarantined in hotels or at home.

However, Morita says that about 30% of those who test positive are hospitalized in Japan, compared to the United States, where the corresponding number is only 2%.