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The story
A Ministry of Internal Affairs and Communications survey found that more than 80% of Japan’s 844 public hospitals ran deficits in fiscal 2024, with total losses reaching ¥395.2 billion. Rising labor costs and inflation are cited as the main factors, and according to the Japan Association of Municipal Hospitals, the same trend is expected to continue into fiscal 2025. On 5ch, opinions split over the causes and possible fixes: some blasted the high labor costs of doctors and nurses, others argued unprofitable departments should be cut, and some noted that patients on welfare (seikatsu hogo) are effectively “guaranteed-payment, ideal customers” for hospitals.
More than 80% of Japan’s public hospitals are running deficits. Why has this happened? What could happen if the losses continue, and are there any solutions? We spoke with Izumi Mochizuki, chairman of the Japan Association of Municipal Hospitals, the nationwide body representing public hospitals.
Hit hard by rising labor costs and inflation
The financial deterioration of public hospitals is severe. According to a Ministry of Internal Affairs and Communications survey, more than 80% of the 844 public hospitals nationwide ran deficits in fiscal 2024, with total losses of ¥395.2 billion. Public hospitals are generally managed under their local government’s special account, with funds also transferred in from the general account budget — but even that isn’t enough. Our own survey at the Japan Association of Municipal Hospitals shows the same trend continuing into fiscal 2025.
Source: asahi.com / Read the original article here
What people said
If it could turn a profit, the private sector would already be doing it
It's because nurses' salaries are insanely high.
Cut them by 30%.
There are just too many public hospitals trying to stock every department under the sun — that's exactly why they're in the red.
Doctors and nurses get paid way too much.
And with free treatment for welfare recipients and the like, no amount of money would ever be enough.
Switch over to an American-style private insurance system.
Wait, doesn't the hospital still get paid when treatment is "free" for welfare recipients?
Opposite, actually. It's fully covered by public funds, so there's zero risk of non-payment. From the hospital's point of view, they're prime customers.
No way that's true
Money is definitely moving around behind the scenes.
Heal yourself.
Keep the sanctions on Tokyo until its birthrate goes up.
Tokyo's birth count actually rose last year.
The rate doesn't climb because people with no intention of having kids keep fleeing the countryside for Tokyo — that's just obvious.
Running public hospitals into the red and raising the tax burden to cover it
just creates a new hidden social security burden for the working generation.
Using the deficit as an excuse to sell things off piece by piece — that's the whole fun of it.
They hand out medication for literally everything these days anyway, which just makes people weaker and weaker.
The heavy fiscal burden of social security spending means that
if taxes are cut, rate hikes and a weaker yen push prices up and squeeze the working generation,
and if taxes aren't cut, the working generation's income gets skimmed off like under the old "gokou-gomin" system (an Edo-era tax scheme where the lord took half of everyone's harvest), squeezing them that way instead.
Elderly people whose healthy life expectancy has stretched out, who could work but don't, and instead live off social security while traveling and enjoying themselves,
are today's aristocrats, today's court nobles, today's feudal lords.
People like that are exactly why social security never reaches the people who truly need it in the amount they need,
and why the working generation keeps getting squeezed under this "gokou-gomin" setup.
If the working generation wants to raise its voice, it should be raising it against these modern-day feudal lords.
Cosmetic surgery means:
・No night shifts
・No long hours on-site
・No handling emergency ambulance cases
・No emergency calls while you're at home
・No emergency operations
・And on top of all that, clearly higher pay than every other specialty
The working conditions are absurdly cushy.
Of course anyone with a medical license is going to aim for cosmetic surgery no matter how much abuse society throws at them for it.
Unless the pay and working conditions in tough, life-or-death specialties like surgery and emergency medicine get better than cosmetic surgery's, it's only natural that more and more talented people keep flocking to cosmetic surgery instead.
Apparently competition in that field is getting brutal too.
Also, once you get older and your own face starts showing it, the clients stop coming.
If it's that profitable, public hospitals should just start offering cosmetic surgery too.
Even JR covers the losses on its money-losing rural lines using profits from the Shinkansen and the Yamanote Line, so overall it's still in the black.
Nope, that's not it. Macro-economically, not everyone can be in the black at the same time — that's the real reason.
Well then, just pull out of the unprofitable areas like JR does, right? lol
The ER, for one, is a department that genuinely just bleeds money — scrapping it alone would change a lot.
Yeah, exactly. Emergency care is a luxury wasted on poor people.
Same goes for pediatrics and obstetrics.
You're stuck waiting a whole hour just to pay the bill.
Raise medical fees and out-of-pocket costs high enough to turn a profit, and patient numbers would crash — the wait times would vanish too.
That's the medical clerks you're talking about.
Whatever AI can replace, just let AI replace it.
Cap annual pay at ¥3 million for nurses and ¥6 million for doctors, and 80% of the hospitals now in the red could turn a profit.
Caregivers at ¥1.5 million, pharmacists at ¥2 million —
cut salaries down to that level and it'd be a real "Sukatto Japan" moment (a TV show famous for satisfying comeuppance segments).
Then teachers should be fine with ¥2 million too, right?
Nobody would want to work there anymore and the place would collapse.
Back in the day, even low-paying public hospitals could get doctors dispatched to them on orders from university medical departments, but nowadays if you try to dispatch someone to a place like that, they just quit the department instead.
Background and Key Points of This Debate
Public hospitals are structurally the ones left holding unprofitable departments — emergency care, pediatrics, obstetrics — that private hospitals pull out of because they don’t pay off, so the deficits themselves are in some sense the flip side of their role as society’s “last resort.” The Ministry of Internal Affairs and Communications survey found that in fiscal 2024, more than 80% of 844 hospitals nationwide ran deficits totaling ¥395.2 billion, with the same trend expected to continue in fiscal 2025. On the thread, many commenters pointed to management-efficiency issues — the high labor costs of doctors and nurses, the “full-set” approach of trying to stock every department, and personnel practices like doctors being parachuted in from university medical departments — while opinions split over whether to blame staff pay or the management structure itself. There was also disagreement over how welfare (seikatsu hogo) recipients’ medical costs affect hospital finances, with some calling them “guaranteed-payment, ideal customers” and others arguing they aren’t a major cause of the deficits — neither side backed their claim with hard numbers. The thread doesn’t get into specifics on the scale of transfers from general-account budgets or how much this varies by municipality, so getting the full picture of the deficits would require checking the Ministry’s original data.
※This article is excerpted and summarized from the 5ch (News Speed+) thread “Public Hospitals: Over 80% in the Red — What Does This “Last Resort” Need to Survive?.”
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