The dilemma of Matsuzawa Hospital in 2013


Happy New Year to all. This year marks the 134th anniversary of Matsuzawa Hospital’s foundation, and we start this year off with the legacy of those many years on the one hand, and the burdens accrued through those years on the other.

Matsuzawa Hospital is one of eight hospitals that fall directly under the jurisdiction of the Tokyo Metropolitan Government. The website of the Tokyo Metropolitan Government defines the basic function of the metropolitan hospital system in the following way: “The metropolitan hospitals aim to provide Tokyo residents with appropriate, government-subsidized medical care of the highest standard and expertise based on a comprehensive medical care platform and to ensure the provision of quality medical services through close cooperation with other medical facilities.” “Comprehensive medical care platform” refers to a system which enables various complications associated with a given condition to be treated in a comprehensive manner. While Matsuzawa Hospital specializes in psychiatry, it has experts in internal medicine, neurology, surgery, plastic and reconstructive surgery, brain surgery, and radiology on its staff and is furnished with various wards to be able to provide this type of comprehensive care.

“Government subsidized” refers to the provision of medical services that are deemed indispensable regardless of the costs involved. As a government-run hospital, Matsuzawa Hospital is responsible for ensuring that emergency psychiatric care is provided 24 hours a day, 365 days a year and that the treatment of physical complications arising from psychiatric conditions, medical care related to the Medical Treatment and Supervision Act, its function as a Medical Center for Dementia, and treatment for substance addiction, including alcohol and drugs, are delivered to patients who need them. In addition, our facility has taken the initiative in promoting activities related to raising social awareness about suicide prevention, clinical trials of new drugs, and research into new testing methods and treatments, and so forth.

Further, in its role as a disaster center hospital, Matsuzawa Hospital is furnished with a heliport on the roof of its new medical ward building and a medical gas piping system, even in rooms that are normally reserved for conferences, so that in emergency situations, medical care can be dispensed there in cooperation with local medical associations or other metropolitan hospitals. All of these services exemplify what is meant by “government subsidized medical care.”

However, this list of services hardly exhausts the medical care provided by Matsuzawa; in addition to these services, there are community-orientated medical services, including outpatient psychiatric care service, inpatient care, daycare, and home visits by nurses. While serving as a psychiatric treatment center for all of Tokyo, by virtue of being a local hospital based in Setagaya Ward, Matsuzawa performs the important function of providing high-quality psychiatric care to residents of the local community. From the perspective of educating physicians as well, it is crucial that Matsuzawa maintain its function as a general psychiatric care provider. The metropolitan hospitals educate and train junior residents for up to two years after their licensing, as well as senior residents aiming to specialize in psychiatry, whose education therefore requires a broad familiarity with psychiatric interventions. Moreover, there is a need to foster medical personnel with a high degree of expertise and insight into psychiatric care to enable them to perform specialized types of government-subsidized medical care. In this sense, no psychiatric hospital can dedicate itself solely to providing government-subsidized medical care.

Herein lies the dilemma of Matsuzawa Hospital. The income of privately-run facilities derives entirely from the medical services they provide; they use this income to pay for personnel costs, the maintenance and renovation of their facilities, and their taxes. In contrast, Matsuzawa Hospital is unable to cover even the personnel costs alone with the income generated by its medical services; it can continue to operate only with the ample funding of taxpayers’ money. Were a hospital like ours to concern itself solely with improving its management with the goal of pushing forward its general psychiatric care program, it would become a significant threat to private institutions. Some people may assert that such as policy is justifiable if the resulting higher quality of medical services benefits the patient. However, in the long run, this cannot be seen to be the correct direction for our institution to take.
As I mentioned earlier, medical care in Japan is provided in accordance with the universal insurance system, which ensures that the same, predetermined medical costs are charged for treatments required for each specific condition anywhere in the country, such that the income garnered from the provision of these services is sufficient to operate the facilities. Were Matsuzawa Hospital, which has recourse to taxpayers’ money to balance its books, to begin delivering an extraordinarily high quality of medical care with utter disregard to the consequences, serious inequality would emerge among citizens, all of whom are subject to the same tax laws and are enrolled in the same insurance system, while also raising the standard of medical care untenably, thus impacting the already overburdened finances of the national insurance system and ultimately threatening its very foundations.

Patients and their families hope for ever higher quality medical services just as health workers do; but the more important consideration is to refrain from putting a price tag on life. It is crucial to preserve a system that ensures that every citizen in need is able to receive the requisite minimum of medical care. This requires that each party not overstep its particular role. To deal with this dilemma, we at Matsuzawa Hospital must avoid the lure of the self-centered satisfaction of being ‘the best’ healthcare provider and instead contribute to the general weal by providing services that are worthy of the not inconsiderable investment of social resources needed to make them feasible, in a manner satisfactory to all.

This year, as every year, Matsuzawa Hospital aims to push forward towards its goal of raising the quality of its medical care and improving its management. As a psychiatric care center already blessed with a new treatment ward housing the latest diagnostic technology and endowed with human resources that compare favorably to those of both private hospitals and other municipal mental institutions, we hope to start this new year by not only continuing to contribute to the wellness of our patients but also becoming the leader in psychiatric care for the entire nation no less than for all Tokyo. To these noble and ambitious ends, all of us at Matsuzawa Hospital humbly ask for your continued guidance and support.