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FY2026 Medical Fee Revision for Hospital Executives: Psychiatric Hospitals, Part 38

2026年7月22日 11:07

Part 38: Psychiatric Emergency Care Is Not Evaluated by Its 'Signboard'—Hospitals Are Selected Based on Admission Performance

When talking with psychiatric hospital executives, I often hear the phrase, 'We provide psychiatric emergency care.'
Certainly, psychiatric emergency care is an essential function for the community.

Accepting patients at night and on holidays.
Responding to involuntary hospitalizations. Coordinating with police and fire departments.
That role is by no means small.

However, looking at the FY2026 medical fee revision, I felt a clear change.

That is,
the government has begun to distinguish between 'hospitals that have' psychiatric emergency care and 'hospitals where' psychiatric emergency care is 'functioning.'

that is what it means.

This revision, for psychiatric emergency hospitals, was perhaps not about 'whether they advertise emergency care,' but rather asking 'whether they are actually supporting regional emergency medical care.'

■ The Value Criteria for Psychiatric Emergency Care Have Changed

Until now, psychiatric emergency care has emphasized 'structural aspects' such as:

Designation status
Participation in rotation systems
On-duty staffing systems

These are, of course, still important.

However, in this revision, regarding psychiatric acute care inpatient fees and emergency medical system additions, a direction was shown that places greater emphasis on actual admission performance and patient conditions.

I believe there is great significance in this.
Because, psychiatric emergency care is a function, not a system.
Even if you hang up a sign, if you cannot accept patients, you cannot protect regional medical care.

■ The 5 Numbers I Look at First

When I receive consultations from psychiatric emergency hospitals, I always check the following numbers:

1. Number of emergency admissions

How much is it needed by the community? This is the most straightforward indicator.

2. Percentage of night/holiday admissions

The true burden of psychiatric emergency care appears at night. The reality cannot be seen during the day alone.

3. Ratio of Involuntary Hospitalizations and Emergency Hospitalizations

This shows the hospital's position in terms of whether it is serving as the region's "last resort."

4. Acceptance Rate

How many emergency requests were accepted. I consider this the most important indicator.

5. Average Length of Stay

How quickly the hospital can accept the next patient after admitting one. This reveals the hospital's bed function.

■ The Real Cause Plaguing Emergency Hospitals

The challenges for psychiatric emergency hospitals are not just a shortage of doctors. Nor is it just a shortage of nurses.

From what I have seen in the field, the most serious issue is the inability to rotate beds.
Accepting emergency patients. However, discharge destinations cannot be determined. Hospitalization becomes prolonged. Beds fill up. The next emergency patient is turned away.

This vicious cycle is not uncommon.

In other words,
the challenges of psychiatric emergency care are not just problems within the emergency department. They are structural problems of the entire hospital.

that is what it means.

■ "Rotation Capacity" Over "Acceptance Capacity"

When looking at psychiatric emergency hospitals, I do not look only at acceptance capacity.
What is truly important is rotation capacity.

Accepting patients. Treating them. Stabilizing their condition. Providing discharge support. Accepting the next patient.

Only when this flow functions does psychiatric emergency care succeed as regional medical care.

■ Why Psychiatric Emergency Care is Important Now

Looking toward 2040, the importance of psychiatric emergency care will continue to rise.

Increase in elderly people living alone
Increase in patients with dementia
Decline in family support capacity
Increase in psychiatric patients with physical comorbidities

If these factors overlap, the number of patients who cannot be supported within the community will increase.
At that point, the final safety net becomes the psychiatric emergency hospital.

Psychiatric emergency care is no longer just one of many hospital functions;it is becoming a regional infrastructure in itself.

■ The Future Envisioned by the Fiscal System Council

When reviewing medical fee revisions, I always check the discussions of the Fiscal System Council.
What is repeatedly emphasized there is not efficiency, but sustainability.

The same applies to psychiatric emergency care. Limited human resources. Limited financial resources.
Amidst this, can we maintain the functions truly necessary for the region?
That is what the government is looking at.

Therefore, the coming era will demand not just systems, but results.

■ Common Traits of Surviving Psychiatric Emergency Hospitals

I believe that strong psychiatric emergency hospitals will share the following common traits in the future.

Do not refuse emergency cases
High acceptance rate
High bed turnover rate
Capable of handling physical comorbidities
Collaborating with general hospitals

In other words, hospitals that operate emergency care not as a ward-level task, but as a function of the entire hospital.

■ Conclusion: What the FY2026 Revision Evaluated

Psychiatric Emergency Acute Care Inpatient Fee. Emergency Medical System Addition.
Looking at these, one can see what the government truly wants to evaluate.

It is not the number of beds. Nor is it whether they are designated or not.
It is the ability to actually accept patients, treat them, and connect them to the next stage when the community is in need.

I believe this revision is not about increasing the burden on psychiatric emergency hospitals, but
a revision to evaluate hospitals that are truly functioning.

And in the future, the value of a psychiatric emergency hospital will be determined not by how many beds it has, but by how much it is needed by the community.

■ Next Preview

Part 39: Psychiatric Hospitals That Cannot Treat Physical Comorbidities Cannot Survive—The Reality Forced by the FY2026 Revision
As the psychiatric patient population continues to age, what do the newly established "Management Addition for Chronic Physical Comorbidities in Psychiatric Patients" and the revised "Psychiatric Liaison Team Addition" signify? In the next installment, I would like to consider the new medical functions required of psychiatric hospitals.

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