The health ministry on Thursday published a list of 424 public medical institutions it has deemed to be in need of possible consolidation and realignment.

The move is aimed at speeding up the streamlining of the medical sector and suppressing ballooning medical costs ahead of an expected spike in the number of people age 75 or older in fiscal 2025.

The ministry is expected to soon request that prefectures draw up plans by September 2020 for dealing with the listed medical institutions, which include publicly run hospitals and hospitals operated by the Japanese Red Cross Society and the Saiseikai Imperial Gift Foundation.

The health ministry is looking to first focus on public institutions that receive public financing and tax benefits in its sector-wide reform plan. The plan will also target private medical institutions.

However, the approach is expected to trigger strong opposition from municipalities and citizens and the reform effort is likely to face difficulty, especially as the ministry request will not be legally binding.

The government has implemented a policy in which prefectures estimate medical care demand and formulate community health care visions to coordinate resource allocation ahead of fiscal 2025, when the post-World War II baby boomer generation will reach the age of 75 or older.

The policy notes that there will be an excess of hospital beds for the “acute phase” of medical care — in which intensive treatment is required — due to the shrinking population, while demand for the “recovery phase” of treatment, or rehabilitation and home care, will rise.

The government is seeking to promote the conversion of treatment functions from the acute phase to the recovery phase. However, such moves have been slow to materialize as the policy to reduce the number of hospital beds is unpopular among local municipalities and residents.

The health ministry sought to break the impasse by investigating a total of 1,455 public hospitals and medical institutions with “highly acute phase” or “acute phase” care functions, especially for care relating to cancer or stroke, as well as emergency treatment. The ministry released the names of institutions that have a significantly low number of treatment cases or where there are other medical institutions nearby that had a similar record of treatment.

Specific reform measures envisaged include transferring perinatal care functions to other hospitals, suspending emergency nighttime medical care functions and other reviews of hospital functions, in addition to reducing the number of beds for acute phase care.

The ministry plans to establish more than 10 “priority regions” around the country in order to directly recommend ways to streamline the medical sector in such areas. It will also request that public hospitals outside the priority regions consider realignment if they do not expect to achieve much conversion of care functions by fiscal 2025.

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