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In Japan, a country that is supposed to have excellent medical care, there have been repeated shortages of hospital beds. The lessons learned from the novel coronavirus pandemic must be applied to countermeasures henceforth.
In order to prepare for new outbreaks of infectious diseases, the revised Infectious Diseases Law and related legislation have been enacted to strengthen the medical system.
The main pillar of the revisions is to oblige hospitals such as public hospitals and government-approved “advanced treatment hospitals” to provide medical care. A new framework will be established whereby prefectural governments and medical institutions sign agreements in advance to determine the services they will offer, such as admitting patients for hospitalization and offering outpatient fever clinics.
In the case of the COVID-19 pandemic, many patients were obliged to recuperate at home due to the lack of hospital beds. Some people were also unable to receive immediate tests. Such a situation must not be allowed to happen again.
The legislative revisions allow governors to issue recommendations or instructions to medical institutions that do not comply with the agreement, as well as to publicize the names of such institutions. If they do not follow the instructions, their status as advanced treatment hospitals and other designations can be revoked.
There were medical institutions that did not accept patients even though they had received subsidies on the basis of having beds for COVID-19 patients. The aim of strengthening the governors’ authority and increasing the effectiveness of the agreement is understandable.
The number of hospitals that will be obligated to provide medical care is expected to reach about 1,700. However, some hospitals are concerned that accepting patients with infectious diseases will prevent them from providing other medical services, resulting in a loss of revenue. Another issue is whether the necessary doctors and nurses can be secured.
It is important for prefectures to take into consideration the actual conditions at medical institutions while preparing as best they can for all possible situations. The government should support the securing of medical personnel and the preparation of hospital beds, rather than leaving this up to local governments.
The pandemic has also highlighted a structural issue in the nation’s medical care system. In recent years, physicians’ specialties have become increasingly segmented by organ and disease. As a result, it has been argued that many physicians have been reluctant to treat COVID-19 patients on the grounds that they do not specialize in this field.
Is it possible to increase the number of physicians who treat infectious diseases by enhancing their training, even if it is not their specialty?
The legal revisions include a supplementary provision calling for a review of the categorization of COVID-19 under the Infectious Diseases Law, with a view to lowering it from the “equivalent of Category II,” which applies to the second most dangerous diseases, to “Category V,” the same category as seasonal influenza.
The number of medical institutions that will be able to treat COVID-19 patients is expected to increase once the disease gets Category V status, but the full cost will no longer be covered by public funds and patients might have to pay part of it out of their own pockets. The government must carefully consider this issue, taking the status of infections and the infectious power of variants into account.
