Centralize and Decentralize Medical Facilities --- How to Make Medical Care the Growth Industry ---
April 30, 2014
Dr. Ryosuke Tsuchiya
Director,
Local Independent Administrative Agency,
Kanagawa Prefectural Hospital Organization
The Rotary Club of Tokyo Ginza
Having worked for the National Cancer Center over many years, I often had a chance to speak on cancer and emphasize the importance of taking medical checkups once a year. I can assure you that 90% of cancers detected through checkups are curable. Regrettably, half of the cancer patients are incurable as they come to hospitals only after experiencing some symptoms when it is often too late.
The Kanagawa Cancer Center will install the carbon ion radiotherapy equipment in fall next year. The National Institute of Radiological Sciences developed this world’s first treatment equipment, still unrivaled today that proves the distinctive advantage of Japan’s basic medicine. I regret to say, however, there is much room for improvement in our clinical practices. I will speak today on how to make medical care one of the growth industries, as advocated by Prime Minister Abe, through centralization and decentralization of our medical facilities.
I entered Keio University School of Medicine in 1964 and completed my six-year course in 1970, right after the student-led protests of 1968-1969. As we staged strikes for two years, I actually finished my studies in four years. My experience convinced me that medical school education can be shortened from the current six years to four years, just like in the US, where students are encouraged to allocate their time on having extensive experience in different fields, such as engineering or literature, and be learned in a variety of issues before practicing medicine. I believe such a diversified basis fortifies the US medical field that has a competitive advantage.
The Ariake Cancer Institute Hospital started as Japan’s first academic institution specialized in cancer in 1908, initiated by professors of pathology of Tokyo University. Its research institute and hospital opened at Sugamo in 1934, supported by the imperial donation from Emperor Taisho as well as a large number of private donations, and have engaged in research and clinical treatment over many years. The Tokyo Women’s Medical University invited Professor Shigeru Sakakibara from Tokyo University to establish the Japan Heart and Blood Pressure Institute in 1955. It makes me proud that both the cancer and cardiovascular departments were founded by private medical institutions. Due to the general trend of “putting the government above the people,” however, the National Cancer Institute was established at Tsukiji in 1962, followed by the National Cerebral and Cardiovascular Center in Osaka ten years later.
Advanced medical treatment is provided mainly by governmental hospitals (university hospitals, general hospitals and cancer centers) or semi-governmental institutes (social insurance hospitals, red cross hospitals etc.). The Ministry of Health, Labour and Welfare, however, admits that medical services in Japan are largely shouldered by private hospitals. Actually they account for over half of the total bed capacity. As most of them are small or mid-sized, their scarce capacity is often overstretched by accepting emergency patients, making it a serious issue in Japan.
Many hospitals in Japan have been refurbished over the past 20 years and they do look impressive. I must say, however, their software is extremely poor. Many hospitals suffer from shortage of physicians and medical specialists. For example, the National Cancer Center with 600 beds has 1,700 staff members and Ariake Cancer Institute Hospital with 700 beds has about 2,000 staff members, while New York Memorial Slone Kettering Cancer Center with 600 beds has about 10 times more staff members, making it one of the leading cancer research institutes in the US.
I have worked for Mayo Clinic in Rochester, a small country town with a population of 80,000 in Minnesota. Thirty years ago, the Clinic had 2,000 beds where 15,000 staff members worked, making it the largest industry in the area. There were 900 physicians and 900 resident physicians, equivalent to the total staff number at the National Cancer Center in Japan. I have learnt that the Clinic has reduced the number of beds, while doubled the number of staff recently to provide extensive outpatient treatment that has become the mainstream for chemotherapy.
The media often points out the issue of “drug lag” or “device lag” as patients in Japan do not have access to medical drugs or devices available in other countries, due to the slow approval system. The Pharmaceuticals and Medical Devices Agency (PMDA) has doubled the number of reviewers to accelerate the approval process, yet the matter is not that simple. Hospitals in the US and European countries are large enough to collect data from clinical trials that facilitates their approval procedure. In Japan, however, hospitals must join forces to collect data, as each hospital is not large enough. It proves that the size of hospitals can have a great impact on the development of health-care.
I feel the need to make hospitals in Japan larger. At the same time, specialized hospitals should build organic collaborative partnerships so that they can face competition from the US and Europe. I suggest to form a medical cluster consisting of hospitals and surrounding research institutes as well as pharmaceutical companies and medical device companies to make medical-care one of our growth industries. I believe we can rebuild medical care in our country by centralizing medical facilities through medical clusters as well as decentralizing medical care through appointing regional health care practitioners. Let me close my speech by asking for your support to bring this plan to life.
Postscript: To train the “regional health care practitioners” will be the key to decentralize medical care. My suggestion is to provide systematic trainings to future practitioners at graduate schools that encompass medicine and medical care, business administration and leadership studies.