最後の砦「収支より命」　赤字の拠点病院救急ルポ

▼"The Pride of a Hospital in the Red" Part 1: Amagasaki General Medical Center article here https://www.kobe-np.co.jp/news/societ... ▼"The Pride of a Hospital in the Red" Part 3: Kakogawa Medical Center article here https://www.kobe-np.co.jp/news/societ... ▼To read all articles in the series "The Pride of a Hospital in the Red" click here https://www.kobe-np.co.jp/rentoku/aka... The Pride of a Hospital in the Red" Prologue: Prefectural Hospitals Tread a Tightrope ■All 10 Facilities in the Red, Internal Funds Depleted When considering community healthcare that protects the lives of residents, many people may be reluctant to discuss money. But what if the hospital's very survival is in jeopardy? Known as the "last bastion," a public hub hospital with a strong presence is now facing a critical deficit. According to the Hyogo Prefectural Hospital Bureau, which operates 10 directly managed hospitals in the prefecture, the operating deficit for fiscal year 2024 will be a record high of 12.849 billion yen. By the end of the fiscal year, the bureau's internal reserves were depleted, forcing it into debt. It is surviving by borrowing from private financial institutions. The bureau's head, Kazuaki Sugimura, Hospital Business Manager, was a pioneer in the nation in restructuring prefectural hospitals and other facilities to increase the sustainability of regional medical care while at Kobe University Hospital. Even Sugimura has said, "From a business perspective, we would have to close some hospitals within the next few years." Of course, the bureau is striving to maintain the status quo, and with the prefecture's credibility, there will be no immediate shortage of funds. However, there is no denying that it is a dangerous "tightrope walk." ◆ The predicament facing hospital management is a nationwide one. According to the National Council of Municipal Hospitals (Tokyo), 86% of member hospitals posted operating losses in fiscal year 2012. The main reason for these huge deficits is that hospitals' revenues from treatment and other activities are fixed at a nationally set price known as "medical fees." For example, last year, prefectural hospital staff wages were raised following a recommendation from the National Personnel Commission. However, medical fees are revised every two years, so increases in expenses during that time are not taken into account. Additionally, rising prices have caused medical equipment and medication prices to soar, with hospitals shouldering the increased costs. The medical community as a whole is calling for increased medical fees, but with calls for cuts in social security spending, it's unclear whether this will be realized. ◆ However, hospitals' sense of crisis is not easily conveyed to the public. "We should just cut doctors' salaries," "Public hospitals are fine because they can be subsidized with tax money," and other such comments are even heard. According to a 2011 survey of the current state of the medical economy, the average annual salary of doctors at public hospitals is a high ¥14.56 million. However, the same survey conducted in 2009 found that the average annual salary of private practice physicians was ¥24.58 million. If doctors leave public hospitals to open their own practices, the hospitals, no matter how impressive their appearance, will cease to function. Previously, university hospitals were solely responsible for sending medical personnel to affiliated hospitals in the region. However, the system changed, and this role has weakened. Doctors are concentrated in urban areas, and hospitals in rural areas have a harder time securing personnel. Meanwhile, it is true that, in accordance with national standards, Hyogo Prefecture allocates a total of approximately 15 billion yen each year from its general account to emergency care and other medical services that are less profitable. However, this still results in huge deficits. Even if the prefecture were to cover the gap with its financial fund, which is its savings, it would not even be enough to cover the deficits of the past two years. ◆ For this article, the Kobe Shimbun asked each hospital to provide on-site reports. Some hospital executives worried that vivid reports of the actual situation would drive staff away. The atmosphere on the ground is filled with such tense, precarious conditions. These public, "deficit-making hospitals" were barely surviving thanks to the determination and pride of their medical staff. Society is aging, and this year all members of the "baby boomer" generation are now in their late senior years. What would happen to elderly people who have cancer or become physically weak if their local hospital suddenly disappeared? Now is the time to rethink community healthcare. (Shinichiro Tsurumi) ▼Subscribe to this channel    / @kobedigital