Mechanism of health care restructuring in the Kamigoto District, Nagasaki Prefecture

Abstract

This study discusses the health care system in the Kamigoto District, Nagasaki Prefecture, which is an isolated island and is treated as a disadvantaged area. The study considers the behavior of each health-related actor inside and outside of the region according to the way in which the actor seeks rationality and equitability. Through health care policy for the isolated islands, the minimum necessary health care services have been maintained with the support of the mainland. The health care policy for the isolated islands in Nagasaki includes the operation of medical institutions, retention of doctors, plans for transportation by helicopter, and the introduction of a medical information system. Nagasaki Prefecture has strengthened health care services in the isolated islands with the help of the universities and local governments. The Nagasaki Hospital Agency, which was established in Nagasaki Prefecture, was intended to operate hospitals together with the cities and towns in Shimabara, Goto, and Tsushima Districts in April 2009. The agency adopts a special district authority that fully applies the Local Public Enterprise Act, and it operates two prefectural hospitals and nine group hospitals. Three hospitals located in Shin-Kamigoto Town were put into operation by the newly created Nagasaki Hospital Agency. The implementation of the health care restructuring plan of Shin-Kamigoto Town proceeded as planned. Each health-related facility in the town clarified its function, and all facilities were closely coordinated with each other, with a view to maintain the current service level and improve management. Inpatient medical care was centralized at Kamigoto Hospital as a local base. In addition, the beds at Arikawa Hospital (currently Arikawa Medical Center), Shin-Uonome Clinic, Wakamatsu Clinic, and Narao Hospital (currently Narao Medical Center) were eliminated. As a result, the total number of beds in the Kamigoto District was reduced by almost half, i. e., from 334 to 186. However, the mainland provides supplementary support because no medical institution has the capacity to supply tertiary and psychiatric inpatient medical care in Shin-Kamigoto Town. A prerequisite for the smooth implementation of the plan is cooperation among Shin-Kamigoto Town, the Nagasaki Hospital Agency, medical institutions on the mainland, and Kamigoto Hospital in maintaining health care services on the isolated island. As described above, the large scale response maintained the health care system on the isolated island by the actors whose jurisdictional area covers all parts of Nagasaki Prefecture encompassing the secondary medical areas outside of Kamigoto District. The phenomenon that multiple actors mobilized health care resources to address the scarcity of such resources is specific to a disadvantaged area. Hence, the process of restructuring health care in the Kamigoto District was accompanied by a review of governance, in which the disadvantageous geographical conditions were overcome not through local governance such as the municipality or a secondary medical area, but by expanding the scale to the level of Nagasaki Prefecture.