Abstract
There had been a policy debate to improve administrative efficiency of public hospitals in rural areas through reform under the “Public Hospital Reform Guidelines,” when the Great East Japan Earthquake struck rural Iwate on March 11, 2011. This report summarized the financial and sociopolitical situations that public hospitals in rural Iwate, local major providers of healthcare, have been facing in the revival course since the Earthquake, in order to identify policy challenges toward improving the financial sustainability of public hospitals in agricultural rural medical districts. Four lessons were mainly extracted, as follows :
(1) Public providers have been playing a significant role in providing healthcare services in agricultural districts in Iwate since before the disaster, and the revival of their capacity is indispensable for recovery of the local community.
(2) Even before the disaster, however, these public providers had already faced financial difficulties and were forced to downsize their services. The situation has not changed and the challenge remains.
(3) Case studies suggested several conditions were required for the revival of public hospitals : trust between the prefectural and municipal governments, public providers, and local residents ; flexible functional division between hospitals and clinics ; and integration of medical, nursing, and welfare programs. The significance of these conditions was brought to light in a more intense manner after the earthquake.
(4) Meeting these conditions is expected to improve the financial sustainability of public hospitals in rural agricultural districts.
