Editorials

The Japanese healthcare system

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7518.648 (Published 22 September 2005) Cite this as: BMJ 2005;331:648

Only 2.5 pediatricians per pediatric department of Japanese hospital: Can each hospital continue to provide a pediatric emergency service?

8429 pediatricians worked in Japanese hospitals (1) and 3359 Japanese
hospitals had a pediatric department (2) in 2002. It is estimated that
there were only 2.5 pediatricians per pediatric department of Japanese
hospital. However, 73.7% of the pediatric departments provide a night and
holiday emergency service (3), and 97% of hospital pediatricians work
consecutively for 32 hours or more when they are on call (not only in-
hospital call but also at-home call) (4). They must be on call every
second or third days on average because of their shortage.

According to Survey of Medical Care Activities in Public Health
Insurance (5), a night-and-holiday charge of children under 6 years old
was paid 535,575 times in September, 2002. By dividing the number by 2475
(73.7% of the 3359) pediatric departments and 30 days, it is estimated
that there were 7.2 night-and-holiday visits of children under 6 years old
per hospital per day. In Japan there is no specialty such as family
medicine and most of children were cared by pediatricians even in
nighttime and holidays. Can hospital pediatricians continue to care sick
children in nighttime and holidays twice a week or more without burn-out?
Labor Standard Law has a weekly working limit of 40 hours, and to be
compliant to the law and run 24 hour pediatrician-caring system, at least
4.2 (24 hour*7 days/40 hours) pediatrician per facility are needed. In
order to run a proper pediatric emergency system, it is needed to
concentrate pediatricians on main medical centers from small rural
hospitals.

References

1) Ministry of Health, labor and Welfare. Survey of Physicians,
Dentists and Pharmacists, 2002 [in Japanese]. Available at:
http://wwwdbtk.mhlw.go.jp/toukei/data/180/2002/toukeihyou/0004386/t00893...

Accessed September 26, 2005.

2) Ministry of Health, labor and Welfare. Survey of Medical
Institution, 2002 [in Japanese]. Available at:
http://wwwdbtk.mhlw.go.jp/toukei/data/160/2002/toukeihyou/0004610/t00948...

Accessed September 26, 2005.

3) Japan Pediatric Society. Future demand of hospital pediatricians.
April 6, 2005 [in Japanese]. Available at:
http://jpsmodel.umin.jp/DOC/demandofpediatricianinfuture.doc
Accessed September 26, 2005.

4) Japan Pediatric Society. Survey of Hospital Pediatric Department
and Pediatricians. May 24, 2005 [in Japanese]. Available at:
http://jpsmodel.umin.jp/DOC/HospPediatriciansAnalysisAbstract.doc
Accessed September 26, 2005.

5) Ministry of Health, labor and Welfare. Survey of Medical Care
Activities in Public Health Insurance, 2002 [in Japanese]. Available at:
http://wwwdbtk.mhlw.go.jp/toukei/data/650/2002/toukeihyou/0004470/t00931...

Accessed September 26, 2005.

Competing interests:
None declared

Competing interests: No competing interests

28 September 2005
Akira Ehara
Research fellow
Koala Medical Research