Investigating the health care delivery system in Japan and reviewing the local public hospital reform

Abstract

Japan's health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying a multivariate analysis and regression model techniques, we show the functional differences between urban populated prefectures and remote ones; the equality gap among all prefectures with respect to the distribution of the number of beds, staff, and doctors; and managerial differences between private and public hospitals. We also review and evaluate the local public hospital reform executed in 2007 from various financial aspects related to the expenditure and revenue structure by comparing public and private hospitals. We show that the 2007 reform contributed to improving the financial situation of local public hospitals. Strategic differences between public and private hospitals with respect to their management and strategy to improve their financial situation are also quantitatively analyzed in detail. Finally, the remaining problems and the future strategy to further improve the Japanese health care system are described.

Keywords: financial performance; health care resource; health care system; multivariate regression model; public hospital.

Figure 1

Number of hospitals by ownership. Note: Data from Survey of Medical Institutions. Ministry of Health, Labour and Welfare; 2002–2013. Available from: http://www.mhlw.go.jp/toukei/list/79-1a.html. Accessed April 15, 2015. Abbreviation: SSO, social security organizations; OP, other public hospitals.

Figure 2

Revenue and expenditure per 100 beds by ownership. Note: Data from The Report of Hospital Operation Monitoring Analysis Survey. Tokyo: Japan Hospital Federation. Available from: http://www005.upp.so-net.ne.jp/byo-ren/2/. Accessed October 15, 2013. Japanese. Abbreviations: LPH, local public hospitals; PRH, private hospital.

Figure 3

Difference of revenue and expenditure per 100 beds. Notes: Data from The Report of Hospital Operation Monitoring Analysis Survey. Tokyo: Japan Hospital Federation. Available from: http://www005.upp.so-net.ne.jp/byo-ren/2/. Accessed October 15, 2013. Japanese.

Figure 4

Difference of medical revenue between PRHs and LPHs per 100 beds. Note: Data from The Report of Hospital Operation Monitoring Analysis Survey. Tokyo: Japan Hospital Federation. Available from: http://www005.upp.so-net.ne.jp/byo-ren/2/. Accessed October 15, 2013. Japanese. Abbreviations: Exp, expenditure; LPH, local public hospital; PRH, private hospital; Rev, revenue.