【特集】持続可能な医療とは？現場の実態と本音：県政課題の実情を深掘り③「医療」【新潟】スーパーJにいがた5月28日OA

There are only three days left until the gubernatorial election. This is the third installment in our series delving into prefectural government issues, focusing on "Medical Reorganization." Due to declining patient numbers and other factors, hospital management is deteriorating, leading to the closure of medical departments and reduction of hospital beds. The management of prefectural and JA Prefectural Welfare Federation hospitals is extremely difficult. On the 28th, the prefecture announced that prefectural hospitals will incur a deficit of approximately 1.5 billion yen in fiscal year 2025. JA Prefectural Welfare Federation, which operates 11 hospitals, also expects to improve its 2025 balance sheet with national subsidies, but its 2024 balance sheet showed a deficit of over 3 billion yen. Securing working capital is an urgent issue for both. The prefecture is working towards a sustainable medical care delivery system by promoting the division of roles among hospitals and the appropriate allocation of personnel, including doctors and nurses. We interviewed staff about the realities on the front lines of medical care and the efforts of hospitals. ――――― On May 18th, a patient was transported to Murakami General Hospital. ■Doctor "It's a knee joint." The patient was a 96-year-old woman. She complained of pain in her left knee and was transported from the Asahi district of the city, about 30 minutes away. ■Emergency Medical Services "We don't know if she fell, but her family found her standing and unable to move (nearby)." The patient says she "doesn't remember" the cause of her injury. Murakami General Hospital, operated by JA Kenkoren, is located in the heart of Murakami City. It covers an area said to be 2.4 times the size of Tokyo's 23 wards, including mountainous areas near the Yamagata Prefecture border and the remote island of Awashima. It is a cornerstone of regional medical care, handling emergency and recovery patients, but is being directly impacted by declining patient numbers and rising prices. The number of beds, which once reached a maximum of 263, has been gradually reduced since 2024. Currently, there are 185 operational beds. In March 2025, the hospital was forced to suspend maternity services. The prefecture is pushing forward with a "reorganization of medical care." Most recently, in March, a new policy was announced designating the Prefectural Central Hospital in the Joetsu region as a "core hospital" handling acute and advanced medical care, and the JA Koseiren Joetsu General Hospital as a "community-based integrated care hospital" handling emergency care and recovery for the elderly. ■Prefectural official (at the time): "The population is declining, the aging population is progressing, and the number of children is decreasing. Given this situation, proactive reorganization with a view to the future is a crucial point. We want to accelerate various initiatives." The reorganization is unavoidable. Dr. Soichi Sugitani, director of Murakami General Hospital, acknowledges that it's "unavoidable," but also harbors concerns. ■Dr. Soichi Sugitani, Director of Murakami General Hospital "I think that excessive centralization, or rather, concentrating too many doctors in large hospitals and urban areas, is causing the loss of essential resources for local communities." What are the essential resources for local communities? ■Dr. Soichi Sugitani, Director of Murakami General Hospital "I think we have to let go of some highly advanced medical care and medical care for a limited number of patients. On the other hand, we must accept as many patients with common local illnesses as possible, otherwise people in rural areas will suffer. It would be regrettable if our inability to adequately respond leads to a reduction in patient care." A 96-year-old woman was brought in by ambulance with pain in her left knee. ■Resident Physician Yuto Oishi "We took an X-ray because we suspected a fracture, but it wasn't clear, so we're considering a CT scan." The X-ray and CT scans revealed that blood had accumulated inside her knee due to a bruise. ■Orthopedic Surgeon Dr. Makoto Shirano "You did well. How's the pain? Is it a little better?" She currently lives alone with her elderly son. ■Orthopedic Surgeon Dr. Makoto Shirano: "I'll put her in my outpatient clinic, so please come back if it hurts. I think you'll be able to go home today." ■Woman's Son: "Can I really go home like this...?" ■Orthopedic Surgeon Dr. Makoto Shirano: "Yes, you can go home." She uses day care services, but she's also caring for her mother while running a farm. ■Woman's Son: "It's rice planting season now, so it would be best if she wasn't home." ■Orthopedic Surgeon Dr. Makoto Shirano: "In that case, we could set a time limit, like a week (for hospitalization)." ■Woman's Son: "That's fine, the rice planting will be finished by then." ■Orthopedic Surgeon Dr. Makoto Shirano: "That's what you say, but the hospit...