午夜剧场

As my specialization is in health policy and health economics, I have a strong interest in the current COVID-19 pandemic. Since I provide support such as data analysis for the Tokyo Metropolitan Government's health policies, I attend health policy-related meetings held in Tokyo between my academic duties and research. Listening to the stories of doctors working on the front lines, it seems that while new problems are being presented in various forms, I also realize that long-standing issues are being called into question in a significant way.

The keyword is "coordination among medical institutions." This challenge has been repeatedly pointed out for a long time—and even now in 2020, the issue of "how regional medical institutions should coordinate to provide appropriate medical care to COVID-19 patients" is being discussed repeatedly. For example, during the first wave starting in March, it was pointed out that even if recovering COVID-19 patients were in high-functioning large hospitals, nearby private hospitals were refusing to accept them due to fears of spreading infection or a decrease in revenue caused by other patients avoiding the facility.

Why is coordination among medical institutions so difficult? One structural factor is the long working hours of hospital doctors. Whether insufficient coordination leads to long working hours, or long working hours lead to a lack of coordination, is a difficult question, but the two are inseparably linked. In reality, it is difficult to expect "coordination" that involves paying attention to various adjustments from hospital doctors who do not even have enough time.

However, what is the situation now? As of July 6, when this article is being written, unnecessary emergency transports—a long-standing concern—have visibly decreased, elective surgeries have been postponed across the board, and there is no congestion in hospital outpatient departments. As a result, many hospitals are expecting a decrease in revenue due to the pandemic. Conversely, it can be inferred that many doctors have more time on their hands. If the final bottleneck to coordination is the loss of revenue associated with accepting COVID-19 patients, the government should quickly implement loss compensation measures, and such voices are loud even at the time of writing. By providing incentives for accepting COVID-19 patients, there is a possibility that coordination among medical institutions, which has been said to be insufficient, will progress in a new form. If functional differentiation and coordination in the region progress and the pressure on medical institutions is eased, citizens will be able to resume economic activities to that extent. "How to face long-standing problems" is what is being demanded even during the COVID-19 pandemic.