Future Community Medicine and Hospital Management from Toyota Kosei’s Perspective

Abstract

The JA Aichi Welfare Federation consists of 8 hospitals, comprising 4 large and 4 mediumsized hospitals. The estimated population of the medical areas that the large hospitals serve has yet to decline notably. In the West Nishimikawa Medical Area, where Anjo Kosei Hospital is located, and in the North Nishimikawa Medical Area, where Toyota Kosei Hospital is located, the population is expected to remain mostly stable even up to 2040. Together with Miyoshi City, Toyota City (population 480,000), where our hospital is located, is in the North Nishimikawa Medical Area and is located to the east of Nagoya City. Due to the Great Heisei Consolidation, the vast mountainous area to the northeast of Toyota City has been incorporated into the city. Then, including the urban area that historically made up the city, this medical area is the largest in Aichi Prefecture. The aging rate is increasing rapidly, and medical demand is expected to increase about 20% (an estimated 140,000 people) by 2040. Therefore, the issue that must be addressed is how to maintain the medical system in the face of rapid population aging in urban areas as well as in the vast mountainous areas,where the population has declined significantly. Our hospital opened as Kamo Hospital in 1947. After moving to its current location in 2008, the hospital was renamed Toyota Kosei Hospital. Although net income was significantly negative shortly after the move, total revenue has been steadily increasing since then. Net profit returned to being positive, but the profit margin of medical practice did not readily increase. In the first hospital director's inaugural year, net profit was only 1.5%. Partly because our hospital moved from the center of Toyota City to its northwestern outskirts, the decrease in patients from the city center and the southern part of the city had an effect. We are promoting changes in hospital management in line with the Community Medicine Concept, promoting an increase in the number of new patients from adjacent medical areas, increasing the referral rate, and promoting reverse referrals to streamline outpatient care functions. By optimizing the number of outpatients, we are seeking to allocate human resources to inpatient treatment and increase inpatient income. Thanks to these efforts, net profit has exceeded 8% in 5 years up to fiscal year 2019. Although we had been aiming to implement reforms to further improve the quality of medical care in the next few years, the impact of the COVID-19 pandemic this year has been immeasurable and has left us struggling. Hospital management has been strongly impacted since April, and no measures have been taken to compensate for the decline in medical income. As the end of the pandemic is unpredictable, the hospital itself needs to change its behavior. At the same time as managing COVID-19 patients in the community, securing income for continuing medical care is an important issue. Community medicine cannot be protected if the hospital cannot survive.