Abstract
This study introduced and discussed the current situation and problems from the viewpoint of the local medical institution in the island area of Tokyo. The Tokyo remote islands are classified into three types according to population size. The study compared the medical conditions among the small, medium, and large islands. Each of the five small islands has a clinic with one doctor, one or three nurses, and a small number of clerks. The islands have differences in population and age distribution, and securing transportation means is often difficult because of their distance. As such, the medical staff needs to use the limited medical resources accurately to carry out medical treatment. In addition, as there are no facilities for older adults, preventive measures and the appropriate care environment must be properly prepared in view of the aging society. Hospitalization for a fixed period is impossible in medical institutions on medium-sized remote islands, which face difficulties in securing human resources capable of handling rehabilitation. Patients often have difficulty resuming their daily life when returning to the island from treatment at a hospital. Disuse and cognitive decline and motor function decline owing to long-term hospitalization often require additional support after discharge. The support and supply system after discharge tend to be limited，and cooperation between medical institutions is important when returning home. Medical facilities on large remote islands have relatively large numbers of staff and hospital beds, and as such, many cases can be handled. However, it is often difficult when and how to consult cases that require more specialty. Several cross-sectional initiatives have been developed, from specialized practice and image transmission systems to blood rotation systems and integrated physician training programs. Each medical institution on the islands must always consider its cooperation with the surroundings so that it can continue to observe strictly its own coverage and contribute better to the medical welfare of residents.
