April 2012
NIRA Report

Revitalizing Medical Care and the Aging City-Measures for Promoting the Concentration of Medical Care in Downtown Areas-

Executive Summary

In 2012, members of Japan’s first baby boom generation will turn 65. Japan itself will
face the transition towards becoming a fully-fledged “super-aging society” with adeclining population. Given this, the achievement of a 180-degree turnaround inconcepts of growth paths for cities predicated upon former levels of expansion of thepopulation, in addition to a transition to a system of provision of medical care capableof supporting a “super-aging society,” are pressing issues.
This report proposes that Japan should attempt to overcome the difficult problem of its
aging and declining population through the implementation of two policies: The
reduction of the size of cities and the concentration of their functions, and theestablishment of a system for the smooth provision of medical and nursing care basedon a model of comprehensive care.
Policy 1: Reduction of the size of cities and the concentration of their functions
Incorporation in urban planning of methods able to promote reduction of the size ofurban areas in line with population decline and the restructuring of infrastructure, andthe high-density concentration of urban functions for which demand will increase in
downtown areas.
Policy 2: Establishment of a system for the smooth provision of medical andnursing care
Legal recognition of a new type of healthcare corporation in the form of a holding
company, established through equity investments by individual healthcare corporations.
These new holding companies would bring together entities providing a diverse rangeof services, including healthcare, nursing care, and urban planning.
A summary of the report is provided below.

1Chapter 1

Thinking about Urban Planning from the Perspectives of Healthcare
and Welfare-Why bring together Healthcare/Welfare and Urban Planning?-

With increases in the lifespan of its citizens, the lifespan of Japan’s child-rearing
generations is now largely the same as that of the generations they raise. The lifestylesof citizens, Japan’s system of medical care and the nation’s cities are all facing turning
points. While circumstances may differ between regional hub cities and major urban
centers, both are now facing the question of how to respond to this unprecedented
phenomenon of “super aging.”z Supportive medical care
What is demanded is a transition from “curing” to “supporting” the lifestyles of theelderly as the purpose of healthcare in a “super-aging” society, and the integration ofcomprehensive healthcare (healthcare for the elderly) with welfare care to create care
networks.
z Urban design that supports the lifestyles of elderly residents
Given that elderly citizens without affiliations to external organizations or structures
will become the majority in future, it will be necessary to make a transition from thecurrent workplace- and residence-centered urban structure towards the positioning ofentertainment, healthcare, etc. as the central axes of urban space, and to design
mechanisms enabling cities to support the lifestyles of elderly residents.
Chapter 2Cities of the Future and Healthcare and Welfare-Reducing the Scale of Cities and Restructuring Infrastructure
for a “Super-aging Society” with a Declining Population-The depopulation of regional cities and the aging of their populations are trends whichhave long been recognized, but in the future these phenomena will also advance
rapidly in the peripheries of Japan’s largest cities. The rate of aging of the populationin the new towns which developed on the peripheries of major metropolitan areas inthe ‘60s and ‘70s is higher than in the surrounding regions, and their infrastructure is
now more than 30 years old and due for repair or replacement. The delay in responding
to the aging of the population in the area of urban functions is also becoming serious.
The question is now arising as to how to deal with the twin problems of the aging of
the population and the aging of urban infrastructure. In order to regenerate urban areas,
it will be essential to achieve an integrated arrangement that enables effective use ofresources and concentrates urban functions which are in high demand through the highdensity realized by reducing the size of the city and concentrating functions (Figure 1).
2This would also contribute to increasing residents’ quality of life (QOL).
Figure 1

Policy package to promote concentration of medical care in downtown areasz A system of urban planning that enable cities to be reduced in size
Reevaluation of urban plans predicated on population increase. Identification ofregions in which tax-funded public services are rationally able to be provided (urbanservice boundaries) by means of cost-benefit analyses of management and maintenanceof infrastructure, making it possible to reduce the scale of cities. At this time,announcement of details of implementation of plans in order to encourage residents tochange their place of residence.
z Governance that promotes the reorganization and concentration of urban functions
Creation of mechanisms for governance able to decide and manage city plans over awide area, encompassing the administrative areas of multiple municipalities, with theparticipation of individuals involved in the fields of healthcare and welfare in addition
to urban planners.
In addition, the creation of new district plans capable of managing the reallocation ofvarious urban functions, as opposed to the current district planning system, which
focuses on the management of physical attributes. Consideration of the establishment
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of a voucher system to encourage residents, in particular the elderly, to move to“concentrated healthcare districts” located downtown, as areas which feature aconcentration of major urban functions, including healthcare and nursing care services
and accommodation for the elderly.
Chapter 3

The Future Healthcare and Nursing Care System-The Necessity for Comprehensive Development of Medical Careand Urban Planning and Reexamination of Related Corporations-Japan’s hospital-centered system of provision of medical care has chiefly focused on
the provision of acute phase care, but as a consequence of the ongoing aging of thepopulation, it will be necessary for the system to make a rapid transition to acomprehensive care model which supports the elderly in maintaining their lifestyles.
However, Japan’s medical care system is centered on private hospitals, andrestructuring to put a new system in place would be difficult under the present systemof laws relating to medical treatment.
Because of this, it will be necessary to proceed by reconsidering and revising thehealthcare corporation system from the three perspectives discussed below while
maintaining a commitment to principles such as not-for-profit operation and fulfillmentof ancillary functions, promoting the mutual collaboration and restructuring ofhealthcare corporations and their integration with entities which provide related
services, in order to create a system for the provision of a full range of healthcare andnursing care services.
z Mutual collaboration between healthcare corporations
Establishment of new healthcare corporations in the form of holding companies.
Granting of rights to individual healthcare providers to hold equity in these newhealthcare corporations and for dividends to be distributed from the new healthcare
corporations to the individual healthcare providers affiliated with them.
z Collaboration with entities providing healthcare and nursing care services
Granting of rights to healthcare corporations established on the basis of the new model
to hold equity (shares) in specified entities providing healthcare and nursing careservices (for example, visiting nursing stations set up by companies, home nursing
agencies, etc.) and to receive dividends.
z Collaboration between new healthcare corporations and entities involved in urban
planning
Granting of rights to new healthcare corporations to invest in urban planningcompanies (consortiums). Application of fixed limits to investment to prevent the4operating status of the urban planning companies from affecting the healthcarecorporations. Examination of potential for urban planning companies to hold equity inhealthcare corporations to enable the orientation of the community, administrators, etc.
to be reflected in the operation of the healthcare corporations within specified limits.
Chapter 4

The Challenge of Realizing a New Form of Urban Planning-An Urban Vision and Urban Management that consider both
People and City-

The new challenges discussed above – the redesign of city structure and the integrated
provision of services with consideration of health, medical care, welfare, and thequality of life of the elderly in order to make cities more compact – are already being
taken up. Attempts are being made to go beyond conventional concepts and make thetransition to a city structure able to respond to unprecedented social changes.
z Concept of a health-, medical care-, and welfare-oriented city
The creation of “healthy roads” (park-like, barrier-free walking spaces) in Tokyo’s
Shibuya Ward (Hatsudai Healthy Road) and Setagaya Ward (Futako-Tamagawa
Healthy Road), seeking to make use of the existing resources of central city areas inorder to realize richer lifestyles for residents.
z Urban planning companies
Creation of mechanisms for the management of a variety of entities centering on urban
planning companies, and the initiation of urban planning schemes which willcontribute to increasing residents’ QOL, in particular in terms of medical care, nursing
care and welfare (See Figure 2).
z Kashiwa no Ha Campus City Project
The Kashiwa no Ha Campus City Project in Chiba Prefecture incorporates mechanisms
for the creation of a healthy city via the knowledge and technological expertisepossessed by the government, universities, and private enterprise, and continues toadvance the creation of a model for cities in a “super-aging” society in which services
are provided in an integrated fashion.
z City management by urban planning companies
The introduction of a system which separates use rights and ownership rights, enabling
the realization of centralized city management, in order to overcome the problems in
the Marugame-Machi Shopping Area in Takamatsu.

5Figure 2

Image of future urban planning

NIRA Report

Revitalizing Medical Care and the Aging City-Measures for Promoting the Concentration of Medical Care in Downtown AreasThe Japanese version of the full report: http://www.nira.or.jp/pdf/1105report.pdfⓒ 2012 by National Institute for Research Advancement (NIRA)

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