On the Future Anxiety of Municipal Hospital Management
“If the hospital is operating at a loss, is it really necessary to raise salaries?”
When I heard those words from a council member, I thought about it again. This is not simply a numerical issue of “a hospital in the red” versus “salary increases,” but rather a theme that touches upon the very nature of what a municipal hospital is.
Differences from Private Hospitals
In a private hospital, if management deteriorates, it is possible to suppress salaries. It is a simple management decision. However, municipal hospitals cannot be discussed using the same logic.
Based on the National Personnel Authority recommendationand linked to the salaries of public servants nationwide
Bearing the responsibility to always mobilize during emergencies such as disasters or pandemics
Being a highly public organization required to follow the policies of the national and local governments
In other words, municipal hospital staff are positioned more as “public personnel serving the community” rather than “workers swayed by management conditions.”
It is not just a “management deficit”
It is true that the hospitals in Kurihara City also carry a deficit on the scale of 1 billion yen every year. This year it is 1.6 billion, and the cumulative deficit has reached 11 billion. However, in the background of this are:
Increased medical demand due to an aging population
Constraints on medical service fees
The role of emergency and remote medical care that cannot be handled by private hospitals
These are factors that cannot simply be dismissed as “lack of management effort.”
Should personnel costs be cut?
Rather, what happens if we lower salaries and invite a brain drain? If we cannot secure doctors and nurses, regional medical care will not be able to function. As a result, the safety of citizens' lives itself will be threatened.
Structural reform is what is needed
So what should we do? I believe that instead of cutting personnel costs, hospital integration and reorganization is the realistic path.
Consolidating the number of hospitals to match the population scale
Collaborating with private businesses that provide home medical care and visiting nursing services
Establish a system where citizens do not lose their 'peace of mind' even if the number of hospitals is reduced
Now that the population is declining, it is time to reconsider the very act of maintaining the physical infrastructure of hospitals.
The question, 'Why are salaries being raised when there is a deficit?' is a valid one. However, I believe it is important to use that question as a starting point to consider what makes municipal hospitals different from private hospitals, and how we will support regional healthcare in the future.