Japan says its world-class health system is buckling under Covid-19 pressure

Questions are being raised over why the government says the medical system is under strain, given Japan's relatively small caseload. PHOTO: AFP

TOKYO (BLOOMBERG) - Coronavirus infections in Japan are at a fraction of major western countries, yet the island nation is signalling increasing concern that its highly rated medical system faces impending collapse.

Though it has the world's longest-living citizens and an abundance of hospital beds and medical equipment, reports of overwhelmed hospitals and deaths from mild infections in quarantine have raised concern. Last week, the government extended a state of emergency over Tokyo and other regions partly due to the insecurity of the health system.

The disconnect is challenging Japan's reputation as a medical resource-rich nation, and is another source of frustration for citizens already unhappy with the country's management of the pandemic, which has been seen as reactive and contradictory.

Given Japan's relatively small caseload of roughly 400,000 infections, questions are being raised over why the government says the medical system is under strain, a description that conjures scenes of overwhelmed hospitals like in worse-hit countries.

Meanwhile, neighbours like South Korea and China have handled their recent Covid-19 waves adequately.

At first, most expected that Japan's health infrastructure would rise to the challenge. Its health system is ranked in the highest decile among 204 places examined by the Universal Health Coverage index, a measure that tracks the effectiveness of 23 different aspects of a healthcare system.

Yet as the pandemic progressed, the system's strengths worked against it, showing how a preponderance of private hospitals geared towards general and preventative care lacks the flexibility to respond quickly. Crucial weaknesses, like a lack of doctors compared to the number of hospital beds, were also accentuated.

"To have the medical system break down like this, we really did not expect it and we have to reflect on it," Health Minister Norihisa Tamura said in a Jan 15 interview with Bloomberg. In the future, the community medical care programmes in Japan would need to have a strategy for pandemic response, he said.

Japan has some 33,000 patients currently requiring hospital treatment and has suffered only around 6,000 Covid deaths, a relatively low number compared to other nations.

Japan's medical system is dominated by private hospitals that make up 70% of the 8,300 institutions nationwide, which includes specialised facilities like psychiatric and long-term care.

During normal times, their competition for business raises the level of service for patients. But in a public health emergency, that's resulted in a lack of coordination: medical systems in some towns or prefectures have empty beds able to take Covid patients while others are overwhelmed.

Unlike in the US and the European Union, there's been no central coordinating effort to transfer patients or medical staff from strained hospitals to those with spare capacity.

In December, the medical systems of Osaka and Hokkaido were under pressure from a surge in Covid-19 patients, and the country had to dispatch medical staff from the Self-Defense Forces to help. Meanwhile, there was ample, unused resources in other prefectures.

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

"The Japanese healthcare system lacks the flexibility to respond quickly to situations," he said. "Things like moving patients or reallocating personnel - you can do that in Europe, but not Japan."

Another snag is that Covid-19 has been given a government designation that requires all patients testing positive to be hospitalised, even if they're not very sick. The rule was relaxed to allow asymptomatic and mild cases to quarantine in hotels or at home.

Still, Morita says about 30% of those testing positive are hospitalised in Japan, compared to the US where the corresponding number is only about 2%.

The majority of private hospitals are small and have no specialised staff trained for infectious disease. Only a third of private hospitals have the necessary requirements to take in coronavirus patients, compared to around three-quarters of public hospitals, according to Japan's health ministry.

Some private hospitals have also been unwilling to pitch into the Covid-19 effort for fear of becoming a site of an outbreak, or being shunned by paying patients.

The government is now subsidising some hospitals up to 19.5 million yen (S$247,000) per bed for serious cases, and has converted some publicly owned hospitals to Covid-only treatment centres. A recently revised law will allow governments to name and shame hospitals that do not take in patients, but this has been criticised by practicing doctors as misunderstanding the constraints that hospitals face.

The country's medical system needs to be better utilised, said Takao Aizawa, the president of the Japan Hospital Association.

"There is a mechanism to protect the community through hospital-to-hospital cooperation," said Aizawa, who is also the head of a private hospital in Nagano Prefecture. "If this system had been functioning, we would not have been in trouble."

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