【病院消滅の危機】「生まれた地域で命の格差があってはならない」8割を超える公立病院が厳しい経営…年間8000人が頼る日本最北の救命救急センターも10億円弱の赤字…模索する“命の砦”に密着

Public hospitals, which have long been responsible for healthcare in rural areas, are now facing a crisis. How will these "fortresses of life" be protected? We followed the northernmost "emergency medical center" in northern Hokkaido. ◆《At the scene of the Nayoro Municipal General Hospital "Emergency Medical Center"…》 Dr. Masaka Ayuta, Emergency Department, Nayoro Municipal General Hospital "She suddenly collapsed, so I'm thinking of leaving in the car. Is that alright? Oh, understood. We'll leave in the car!" Nayoro Municipal General Hospital, located in northern Hokkaido, has Japan's northernmost "emergency medical center." Dr. Masaka Ayuta of the Emergency Department stands on the scene. She is in her third year of her career. A report came in from the local fire department: "A woman collapsed while weeding." Dr. Masaka Ayuta, Emergency Department, Nayoro Municipal General Hospital "I did an ultrasound. I haven't interviewed her yet." She gets into the doctor car and heads to the scene where the patient is waiting, accompanied by a nurse. Dr. Masaka Ayuta, Emergency Department, Nayoro Municipal General Hospital "Heading towards the station." In emergency situations, every second counts. The ambulance meets the patient at their location, and the patient is immediately transported to the emergency center for treatment. Dr. Masaka Ayuta, Emergency Department, Nayoro Municipal General Hospital "So, you stood up from where you were sitting several times, carrying something, and then everything went black? Is that correct? Yes, I understand. Is this the first time you've collapsed like this? Has it happened before?" While Dr. Ayuta and her team are treating the patient, another patient is brought in. Firefighter transporting the patient "Normally, she could move around in her wheelchair on her own, but since yesterday, it's been a bit shaky... Today, she says it hurts when she tries to move and she can't move..." Doctors, nurses, and other medical staff at the emergency center quickly assess the patient's condition and decide on a course of action. ◆《A “Fortress of Life” that Accepts 8,000 Patients Annually…Hospital Also Facing a Deficit of Nearly 1 Billion Yen》 Nayoro Municipal General Hospital, Emergency Department, Dr. Masaka Ayuta “Let me touch you. Does it hurt here? A little lower, here? I want to take imaging tests to find out where it hurts and why. Have you had any imaging tests recently?” 24 hours a day, 365 days a year. Approximately 8,000 patients are brought to the northernmost emergency medical center annually. Nayoro City in northern Hokkaido has a population of about 24,000. Nayoro Municipal General Hospital has about 300 beds and covers almost the entire northern Hokkaido region, comparable to the four prefectures of Shikoku. It is a core hospital in the “tertiary medical area,” one of six areas within Hokkaido that accepts patients requiring advanced medical care. However, the harsh realities surrounding regional medical care are not unique to this hospital. Nayoro City Mayor Takeshi Kato "We are projected to incur a deficit of nearly 1 billion yen. If this situation continues for another year or two, the hospital will be in a critical situation that cannot be ignored. I believe this is a critical situation that could have a significant impact not only on the hospital but also on the finances of the local government." ◆《Emergency medical care is a regional infrastructure…but more than 80% of public hospitals are in the red》 Designated as an emergency medical center in 2015. It accepts transport by doctor helicopter and operates a doctor car. This is the scene at Japan's northernmost "emergency medical center." It is impossible to predict when, where, or what kind of patients will be brought in. Nayoro Municipal General Hospital Emergency Medical Center Director Daiki Sunada "Since this is emergency medical care, it is an infrastructure like electricity and water. Even in rural areas, I believe that it is naturally expected that such things should be available as a matter of course." Advanced diagnostic emergency medical care is a "fortress of life." However, it is a huge burden for hospitals run by local governments. Currently, more than 80% of public hospitals nationwide are operating at a deficit. Muroran City, located on the Pacific coast of Hokkaido, announced the closure of its municipal general hospital in February of this year. Muroran City Mayor Takeshi Aoyama: "The hospital's financial situation has reached a critical level that could cause Muroran City to fall into financial distress within a few years..." Medical fees and drug prices are government-mandated, and hospitals cannot raise them based on their own circumstances. Changes in medical needs due to population decline and aging, along with a serious shortage of doctors and nurses, are creating a reality in rural areas where hospitals are on the verge of collapse. Nayoro Municipal General Hospital, which s...