Where do Nishio citizens go when they get sick? — Our medical sphere, which cannot be seen from the city hospital's deficit alone (Nishio Mirai Shimbun)
When talking about Nishio Municipal Hospital, I hear these voices from those around me.
"We go to Anjo Kosei Hospital."
"If you're from Hazu, it's easier to go to Gamagori City Hospital."
"I had my surgery in Kariya."
"My primary care physician referred me to a different hospital, not the municipal hospital."
Of course, there are also people who use Nishio Municipal Hospital. There are those who were transported by ambulance, those who were hospitalized or had surgery, those who visit the outpatient clinic regularly, and those who have visited many times to see family members.
However, when Nishio citizens get sick, which hospitals do they actually go to? We know almost nothing about the overall picture.
The stories we hear around us are still just "impressions."
That is precisely why, before deciding the future of Nishio Municipal Hospital, we need to investigate the flow of citizen patients.
We are conducting a citizen survey
You can answer for not only yourself but also for the medical experiences of those close to you, such as parents, children, family members, friends, and acquaintances, one person at a time.
The basic part of the survey takes about 2 minutes to complete. We do not collect names or specific disease names.
Take the survey
The "management" of Nishio Municipal Hospital and the "medical care" of Nishio citizens are not the same thing
Nishio City has currently established the Nishio Municipal Hospital Future Review Committee to consider the hospital's management structure, collaboration with surrounding medical institutions, and the differentiation of medical functions.
The first committee meeting will be held on July 31, 2026.
Also, a public comment period regarding the future of Nishio Municipal Hospital will be open from August 5 to September 4. A summary of the submitted opinions will be reported to the review committee and is scheduled to be published on the website.
The background to the city's review of the hospital's future is its severe financial situation.
FY2024 Nishio City Hospital Business Accounting Settlement Report shows that the net loss for fiscal year 2024 was approximately 1.719 billion yen. The total amount transferred from the general account was approximately 1.959 billion yen.
However, this approximately 1.96 billion yen cannot all be called "covering the deficit." Of that amount, approximately 1.573 billion yen is considered an expense that should be borne by the general account under Ministry of Internal Affairs and Communications standards, such as for emergency medical care.
Public hospitals also provide medical care that is difficult to maintain based on profitability alone.
The problem is that while it cannot be simply dismissed as "unnecessary because it is in the red," there is no guarantee that the current management and medical functions can continue as they are.
The same settlement report shows that the number of inpatients decreased by 9,073 and the number of outpatients decreased by 5,120 from the previous fiscal year. Also, according to the FY2024 Implementation Status of the Management Enhancement Plan , against the goal of increasing the number of full-time doctors by 9 from the beginning of FY2022, the number of doctors remains at 55. The number of regular doctors has decreased from 54 to 51, while the number of fiscal-year-appointed doctors has increased from 1 to 4.
In short, the problem in Nishio is not just the financial burden.
We must look at how patient numbers, bed utilization, securing doctors, and available medical functions influence each other.
Is it a problem for citizens to go to hospitals outside the city?
The fact that Nishio citizens use Anjo Kosei Hospital, Hekinan Municipal Hospital, Gamagori Municipal Hospital, Kariya Toyota General Hospital, Okazaki City Hospital, etc., is not necessarily a problem in itself.
There is rationality in concentrating advanced surgeries and specialized treatments in hospitals equipped with the necessary facilities and doctors.
On the other hand, the meaning cannot be understood from the fact that they are 'going outside the city' alone.
The individual may have chosen it based on expertise and treatment track record.
They may have been referred by their primary care physician.
It may be that Nishio Municipal Hospital lacked the necessary medical departments or full-time doctors, leaving them no choice but to go outside the city.
They may have been transported by ambulance and had no choice in the matter.
Some people may have received advanced treatment outside the city and returned to Nishio during their recovery phase.
We cannot lump all of these together as 'the municipal hospital is not being chosen'.
What should be investigated is not a hospital popularity ranking, but
who goes to which hospital, from which area, for what reason, and what kind of burden they feel.
This is the patient's flow.
Hospital reorganization across the country was not just about reducing the number of hospitals by one.
Looking at the reorganization of public hospitals nationwide, it becomes clear that it cannot be explained by the single word 'integration'.
Chutoen, which consolidated acute care into one new hospital
In Shizuoka Prefecture, the acute care functions of Kakegawa City General Hospital and Fukuroi Municipal Hospital were consolidated into the new Chutoen General Medical Center.
According to the case study of the reorganization of Chutoen General Medical Center by the Ministry of Health, Labour and Welfare, the total development cost for the new hospital, medical equipment, and information systems was approximately 22.15 billion yen. Compared to when it opened, the number of doctors increased by 43, including part-time and resident doctors, and a system was established to accept over 5,000 emergency transports annually.
However, this does not mean that all medical functions were removed from the regions where the old hospitals were located.
On the Fukuroi side, a post-acute support hospital for recovery, convalescence, and rehabilitation was established, utilizing the old hospital facilities.
They created a system to return patients to the community after treatment while consolidating acute care into one location.
Sakata, which unified management and divided the roles of two hospitals
In Sakata City, Yamagata Prefecture, the Prefectural Nihonkai Hospital and the Municipal Sakata Hospital were reorganized into a single local independent administrative agency.
The Ministry of Health, Labour and Welfare's case study material shows that acute and advanced medical care was concentrated at the Nihonkai General Hospital, while the other was converted into a hospital for recovery and chronic care.
The number of doctors at both hospitals increased from 112 to 158, and the number of surgeries increased by about 1,000 per year. Meanwhile, the total number of hospital beds was reduced by 168.
Here, too, they did not simply change the management entity.
They specifically reallocated doctors, medical departments, emergency services, and hospital beds within the region.
The two-hospital system that began in Handa and Tokoname, Aichi Prefecture
In Aichi Prefecture, the Handa Municipal Hospital and the Tokoname City Hospital integrated their management in April 2025, and the Chita Peninsula General Medical Organization was launched.
While keeping both hospitals, the Chita Peninsula General Medical Center handles advanced acute care and emergency life-saving, while the Chita Peninsula Rinku Hospital handles acute care, recovery, community-based integrated care, and home support.
However, because it has just begun, it is not yet possible to evaluate how securing doctors and financial burdens will change in the long term.
While it serves as a reference for the system, it is also necessary not to label it a "success story" at this point in time.
What we still don't know in Nishio
Even if we know about national examples, it does not mean that the answer for Nishio will emerge directly from them.
To make a judgment in Nishio, at least the following information is necessary.
1. Hospitals actually used by citizens
Are the destinations for patients the same in the former Nishio City, Isshiki, Kira, and Hazu?
There is a possibility that the places visited for medical care differ depending on the living area, such as the Anjo area for the central part of Nishio, and the Gamagori area for Hazu.
2. Reasons for going to hospitals outside the city
Did the individual choose it, were they referred, was the municipal hospital unable to provide treatment, or was it an emergency transport?
Even if it is the same 'out-of-city medical visit,' the meaning is completely different.
3. Flow of ambulances and referrals/transfers
From which district are patients being transported to which hospital?
Are patients referred from Nishio Municipal Hospital to outside the city able to return to Nishio after treatment?
Regional medical care cannot be evaluated without looking at the connections between hospitals.
4. Citizen mobility and family burden
Time to get to the hospital, transportation costs, family pick-up and drop-off, hospital visits during inpatient stays, and the impact on work and nursing care.
Even if hospital accounting expenditures are reduced, if that burden has simply shifted to individual citizens, it cannot be said that the burden on the entire region has decreased.
5. Results of comparing multiple proposals using the same yardstick
At the very least,
A plan to maintain and strengthen Nishio Municipal Hospital independently
A plan to integrate management with hospitals such as Hekinan Municipal Hospital and keep multiple hospitals
A plan to consolidate acute care into one hospital and leave other functions at the current location
A plan to narrow down the role of Nishio Municipal Hospital based on cooperation with Anjo, Gamagori, Hekinan, etc.
must be compared using the same indicators.
What we want to see shown are the number of doctors, the number of emergency patients accepted, transport times, remaining medical departments, hospital beds, long-term burdens including construction, equipment, and systems, and the burden on patients and their families.
Calculations are also necessary for cases where doctors cannot be secured as planned or where the number of patients is lower than expected.
We want to make patient flows visible based on citizens' experiences.
The administration and hospitals possess data such as medical receipts, referrals/transfers, and emergency transport records.
On the other hand, there are things that cannot be understood from data alone.
Why did they choose that hospital?
What difficulties did they face by traveling outside the city?
How many times did family members have to provide transport, and how much work did they have to miss?
Were there times when they wanted to choose the municipal hospital but could not?
Nishio Mirai Shimbun will be conducting a survey to hear about citizens' experiences with medical care.
We are planning a format where you can provide responses not only for yourself, but also for parents, family members, children, or acquaintances who do not use the internet, one person at a time.
We will collect and tabulate experiences separately based on whether they are your own, those of a family member you accompanied, stories heard directly from the person, or hearsay.
This is not a public opinion poll based on random sampling.
It is also not a survey intended to definitively state what percentage of Nishio citizens choose which hospital.
It is a survey to discover hypotheses that cannot be seen from administrative data alone, based on citizens' experiences, such as what patient flows exist in which districts, and what inconveniences or sense of security are felt.
We are conducting a citizen survey.
You can provide responses one person at a time for yourself, as well as for parents, children, family members, friends, and acquaintances.
The basic part of the survey takes about 2 minutes to complete. We will not collect names or specific disease names.
Take the survey
What should we convey in the public comment?
This public comment is not asking for approval or disapproval of the completed integration plan.
The city explains that the opinions received will be used as one of the important materials for future consideration.
That is precisely why citizens can provide opinions not just on conclusions like "I want it to remain" or "It should be downsized because it is in the red," but also on:
what they want investigated
which options they want compared
what data is necessary for making a judgment
which burdens must not be overlooked
as feedback.
Furthermore, after specific plans and estimates are presented, there must be another opportunity for citizens to voice their opinions.
If we only listen to opinions at a stage where neither the options nor the impacts are known, citizens cannot make responsible judgments.
Formulating questions before answers are reached
Analysis by experts is necessary.
Citizens alone cannot sufficiently analyze hospital internal finances, medical performance, medical demand, receipts, emergency transport, and future projections.
However, rather than just waiting for expert reports, we can:
what must be compared in order to have truly judged the future of the hospital?
We can pose this question from the citizens' side first.
Under what management structure should Nishio City Hospital remain?
There is something we want to consider before that.
Where do Nishio citizens actually go when they get sick? What kind of medical care do they receive there, and what inconveniences or sense of security do they feel? Which medical services must absolutely be kept within Nishio City?
It is not just the hospital's name or building that we must protect.
It is the ability for Nishio citizens to reach the necessary medical care when they fall ill.
I would like to formulate questions for that purpose based on the experiences of our citizens.
Reference Materials and Links
Nishio City / Nishio Municipal Hospital
FY2024 Nishio City Hospital Business Accounting Settlement Report
Nishio Municipal Hospital Management Strengthening Plan Implementation Status Report (FY2024)
Public offering and specifications for Nishio Municipal Hospital future review support services
Nishio Municipal Hospital 'Consideration of Fundamental Reform Proposals'
Examples of hospital reorganization nationwide
*As a general rule, the numerical values in this text refer to publicly available data from the aforementioned local governments, hospitals, and the Ministry of Health, Labour and Welfare. Since conditions and timeframes differ for nationwide examples, they are treated as material for comparison rather than being applied directly to Nishio.