Japan’s Health System Exposed as Empty Hospitals Reject Covid-19 Patients
Robin Harding, Kana Inagaki and Leo Lewis in Tokyo
Financial Times
Virus reveals structural problems caused by bureaucracy and too many small, ill-equipped facilities
The coronavirus outbreak has pushed Japan’s health system close to collapse © REUTERS
Fumiue Harada thought his job was done when he sent a dehydrated 81-year-old off to the local hospital. Then a colleague called: the patient’s CT scan showed a risk of Covid-19 and they needed to get him to a specialised hospital immediately.
So began Dr Harada’s marathon search for a hospital willing to accept a suspected case of coronavirus. “It took seven hours but I eventually found a hospital that would take him 40km away,” said Dr Harada, who runs a primary care clinic in the east of Tokyo.
In some cases, patients have been turned away from dozens of hospitals, even though Japan, with fewer than 15,000 cases, has relatively few Covid-19 patients. It also has more hospital beds a head than any other country in the world: twice as many as France and almost five times as many as the US.
Japan has drawn close to the limit of its health capacity in recent weeks, forcing it to declare a state of emergency. The coronavirus outbreak has exposed longstanding structural problems caused by bureaucratic inflexibility and a plethora of small hospitals.
“We have a lot of beds but a limited number equipped for critical care,” said Shigeru Omi, one of the doctors leading Japan’s fight against coronavirus, in a recent interview with the Financial Times.
Japan has about 6,000 intensive care beds, about the same number a head as the UK, but only a quarter of the US.
Healthcare in Japan is funded by universal public insurance but delivered largely by the private sector, said Motohiro Sato, a health economist at Hitotsubashi University in Tokyo. Many hospitals grew out of successful medical practices and have 100 to 200 beds, compared with 800 to 1,000 in a large university hospital.
These smaller hospitals do not have the resources to run an intensive care unit or maintain negative pressure rooms for infectious diseases. What is more, accepting Covid-19 patients puts everything else they do in jeopardy, and so many refuse to treat them.
“You can offer them high compensation but you can’t make them take corona patients,” says Prof Sato. “From their point of view, if they take coronavirus patients they risk infections within the hospital.”
When Japanese hospitals treat a coronavirus patient, they can disinfect the ward and carry on almost immediately. But a Covid-19 infection caught in a hospital means 14 days of quarantine for medical staff during which it cannot accept new patients or emergency visits.
“There could be a risk that the hospital would collapse, so it takes a certain amount of courage to co-operate in taking care of coronavirus patients,” said Dr Mitsuyoshi Urashima, a professor at Jikei University School of Medicine. In a book published in 2013, Dr Urashima warned about the vulnerability of Japan’s medical system to a pandemic.
Jikei University treated passengers from the Diamond Princess cruise ship in February, but after suffering an in-hospital infection in April, it was forced to close to new patients. According to the Japanese Nursing Association, there have been infections inside 54 facilities across the country.
The other bureaucratic factor is the categorisation of Covid-19 as a disease requiring compulsory hospitalisation. In the early days of the outbreak, the country’s precious infectious disease beds filled up with barely symptomatic patients. To be released, they needed two negative tests, so they sometimes occupied those beds for more than a month.
The owner of one of Japan’s largest chains of hospitals, who asked not to be named, said that coronavirus patients do not use any of his capacity of 5,000 beds because they are not classed as infectious disease beds. Many are empty because people are postponing non-essential treatment during the pandemic.
Dr Hiroki Ohashi, who has started special morning hours for patients with Covid-19 symptoms at his clinic in Kawasaki, said: “The big hospitals nearby were getting drained, having to deal with a spike in the number of coronavirus patients that require hospitalisation and those visiting with coronavirus-like symptoms.”
The moment of peak absurdity came a few weeks ago, said Dr Ohashi, when the National Cancer Centre began taking coronavirus patients. But he said the situation in the Tokyo area has begun to improve: “The peak was probably one or two weeks ago.”
Since then, Japan’s big cities have started renting out hotels to quarantine patients with light symptoms, relieving the pressure on the hospitals, while the number of institutions accepting Covid-19 patients has increased.
“Another possibility is to allow more online treatment,” said Prof Sato.
Financial Times
Virus reveals structural problems caused by bureaucracy and too many small, ill-equipped facilities
The coronavirus outbreak has pushed Japan’s health system close to collapse © REUTERS
Fumiue Harada thought his job was done when he sent a dehydrated 81-year-old off to the local hospital. Then a colleague called: the patient’s CT scan showed a risk of Covid-19 and they needed to get him to a specialised hospital immediately.
So began Dr Harada’s marathon search for a hospital willing to accept a suspected case of coronavirus. “It took seven hours but I eventually found a hospital that would take him 40km away,” said Dr Harada, who runs a primary care clinic in the east of Tokyo.
In some cases, patients have been turned away from dozens of hospitals, even though Japan, with fewer than 15,000 cases, has relatively few Covid-19 patients. It also has more hospital beds a head than any other country in the world: twice as many as France and almost five times as many as the US.
Japan has drawn close to the limit of its health capacity in recent weeks, forcing it to declare a state of emergency. The coronavirus outbreak has exposed longstanding structural problems caused by bureaucratic inflexibility and a plethora of small hospitals.
“We have a lot of beds but a limited number equipped for critical care,” said Shigeru Omi, one of the doctors leading Japan’s fight against coronavirus, in a recent interview with the Financial Times.
Japan has about 6,000 intensive care beds, about the same number a head as the UK, but only a quarter of the US.
Healthcare in Japan is funded by universal public insurance but delivered largely by the private sector, said Motohiro Sato, a health economist at Hitotsubashi University in Tokyo. Many hospitals grew out of successful medical practices and have 100 to 200 beds, compared with 800 to 1,000 in a large university hospital.
These smaller hospitals do not have the resources to run an intensive care unit or maintain negative pressure rooms for infectious diseases. What is more, accepting Covid-19 patients puts everything else they do in jeopardy, and so many refuse to treat them.
“You can offer them high compensation but you can’t make them take corona patients,” says Prof Sato. “From their point of view, if they take coronavirus patients they risk infections within the hospital.”
When Japanese hospitals treat a coronavirus patient, they can disinfect the ward and carry on almost immediately. But a Covid-19 infection caught in a hospital means 14 days of quarantine for medical staff during which it cannot accept new patients or emergency visits.
“There could be a risk that the hospital would collapse, so it takes a certain amount of courage to co-operate in taking care of coronavirus patients,” said Dr Mitsuyoshi Urashima, a professor at Jikei University School of Medicine. In a book published in 2013, Dr Urashima warned about the vulnerability of Japan’s medical system to a pandemic.
Jikei University treated passengers from the Diamond Princess cruise ship in February, but after suffering an in-hospital infection in April, it was forced to close to new patients. According to the Japanese Nursing Association, there have been infections inside 54 facilities across the country.
The other bureaucratic factor is the categorisation of Covid-19 as a disease requiring compulsory hospitalisation. In the early days of the outbreak, the country’s precious infectious disease beds filled up with barely symptomatic patients. To be released, they needed two negative tests, so they sometimes occupied those beds for more than a month.
The owner of one of Japan’s largest chains of hospitals, who asked not to be named, said that coronavirus patients do not use any of his capacity of 5,000 beds because they are not classed as infectious disease beds. Many are empty because people are postponing non-essential treatment during the pandemic.
Dr Hiroki Ohashi, who has started special morning hours for patients with Covid-19 symptoms at his clinic in Kawasaki, said: “The big hospitals nearby were getting drained, having to deal with a spike in the number of coronavirus patients that require hospitalisation and those visiting with coronavirus-like symptoms.”
The moment of peak absurdity came a few weeks ago, said Dr Ohashi, when the National Cancer Centre began taking coronavirus patients. But he said the situation in the Tokyo area has begun to improve: “The peak was probably one or two weeks ago.”
Since then, Japan’s big cities have started renting out hotels to quarantine patients with light symptoms, relieving the pressure on the hospitals, while the number of institutions accepting Covid-19 patients has increased.
“Another possibility is to allow more online treatment,” said Prof Sato.
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