The Missed Lessons of the COVID-19 Crisis: A Lost Opportunity for Healthcare Reform in Japan
The Government’s Response to the COVID-19 Crisis
When COVID-19 infections began to spread, the government called on a wide range of medical institutions to accept patients without sufficiently distinguishing between their capacities to handle infectious diseases. In addition, it implemented policies that provided substantial subsidies for hospital beds designated for COVID-19 patients in order to encourage the establishment of treatment capacity.
However, having numerous medical institutions accept infected patients also meant dispersing sources of infection across a broader area. As a result, the risks of hospital-acquired infections and the burden on healthcare workers may have become more widespread.
In such a public health emergency, establishing designated hospitals specializing in the treatment of COVID-19 patients and concentrating patient care within those facilities could have been a viable alternative. By centralizing infected patients in selected institutions, it may have been possible to improve infection control and accumulate specialized expertise more efficiently.
To be fair, the government’s decision to seek cooperation from a broad range of medical institutions was likely driven by concerns that a limited number of designated hospitals would be unable to cope with the rapid increase in patient numbers. Nevertheless, this approach may also have resulted in the fragmentation of medical resources, making efficient utilization more difficult.
Recognizing the Different Roles of Private and Public Hospitals
Private hospitals are not charitable organizations; they must maintain financial viability while providing medical care. Consequently, many private institutions are not equipped with the facilities, personnel, or infrastructure necessary to respond to rare and unforeseen infectious diseases during normal times.
Public hospitals, on the other hand, receive public support and are expected to fulfill broader social responsibilities than private medical institutions. Providing care in situations where profitability is not the primary consideration, such as during infectious disease outbreaks, is one of their important missions.
Given these differences, it may have been worth considering the establishment of infectious disease centers based primarily within public hospitals when an emerging infectious disease appeared. Medical specialists and resources could have been concentrated in these centers, while university hospitals and other advanced medical institutions could have supported the treatment of particularly severe or complex cases.
Under such a system, medical institutions outside the designated centers could have continued providing care for patients with non-COVID illnesses, helping to preserve the overall functionality of the healthcare system.
The Government’s Actions After the Crisis Subsided
As vaccination became widespread and viral mutations reduced the severity of the disease, COVID-19 was reclassified under Japan’s Infectious Diseases Control Law as a Category 5 disease in May 2023.
Following this change, the Ministry of Health, Labour and Welfare indicated that refusing treatment solely because a patient had COVID-19 could constitute a violation of a physician’s duty to provide care, and it encouraged medical institutions to accept COVID-19 patients more broadly.
However, a change in legal classification did not mean that the virus itself had disappeared. Medical institutions lacking adequate infection-control measures still faced significant risks of healthcare worker infections.
If infections among healthcare workers became widespread, staffing shortages could have affected the treatment of patients suffering from illnesses unrelated to COVID-19, thereby impacting the broader healthcare system. A more flexible approach that took into account the capabilities of individual medical institutions may therefore have remained necessary even after the easing of restrictions.
Preparing for the Next Infectious Disease Crisis
The COVID-19 pandemic presented Japan with a valuable opportunity to reassess its healthcare system.
It highlighted numerous issues, including the division of responsibilities between public and private hospitals, the establishment of infectious disease centers, and the creation of mechanisms that would allow medical resources to be mobilized rapidly during emergencies. Yet it is difficult to argue that these issues have been thoroughly examined and translated into fundamental reforms.
Of course, there is no single correct approach to managing an infectious disease outbreak. Nevertheless, if Japan is to avoid repeating the confusion experienced during the COVID-19 pandemic, it must learn from that experience and develop a more flexible and resilient healthcare system during normal times.
The COVID-19 crisis should not simply be remembered as an event of the past. Rather, it should serve as a catalyst for strengthening and improving Japan’s healthcare system in preparation for the challenges that lie ahead.
