保健医療科学

2023

Vol.72 No.1 p.43－51

Topics: Recent topics in public health in Japan 2023

＜ Reviews ＞
Community Health Care Vision:
Toward realizing the desired medical service system
TANEDA Kenichiro 1), KAKINUMA Tomohiro 2), NAKANISHI Yasuhiro 2),
KOBAYASHI Kenichi 2), AKAHANE Manabu 2)
1)
2)

Department of International Health and Collaboration, National Institute of Public Health
Department of Health and Welfare Services, National Institute of Public Health

Abstract
Given the changes in Japan’s demographic structure, specifically the declining birthrate and aging population, as well as the declining working-age population that includes medical personnel, the construction ofan efficient medical service system has become an urgent issue, necessitating the promotion of functional
differentiation and cooperation of medical institutions. In order to promote such differentiation and cooperation the “Community Health Care Vision” is formulated based on estimates of the medical demand andnumber of beds required in FY2025 by medical care function (advanced acute phase, acute phase, convalescence phase, and chronic phase) in each region/community. Efforts in this direction began in all prefecturesby 2017, until the COVID-19 outbreak in 2020 shifted the focus of medical institutions toward the infected.
In December 2020, the Health Policy Bureau of the Ministry of Health, Labour and Welfare compiled the“Concept for building a future medical service system based on the novel coronavirus disease,” which includes ideas and means to advance the Vision. In March 2021, the Health Policy Bureau Notification, “Howto advance the Community Health Care Vision” was issued, which stated that “The significance of functional differentiation of hospital beds and collaboration was recognized again, having faced the Covid-19 pandemic,” and as one of the three reforms in anticipation of the medical service system in 2040 (realization of
optimal placement and cooperation of medical facilities; work style reform of doctors and medical staff; andeffective measures against uneven distribution of doctors), continuous efforts are being made.
keywords: Community Health Care Vision, demographic structure, Community Health Care Vision Committee, Bed Function Report, training(accepted for publication, January 23, 2023)

I. Background: From “Rapid increase in older
adults” to “Rapid decline in working-age population”
Japan’s total population (population of Japanese nationals + population of foreign nationals) declined below theprevious year’s level in 2005 for the first time since WorldWar II; peaked in 2008; and has been declining for 11 consecutive years since 2011[1]. As of October 1, 2021, thetotal population of Japan stands at 125,502,000, which is adecrease by 644,000 (-0.51%) in the one-year period from
October 2020 to September 2021. This decline was thelargest since 1950, when comparable data are available. Additionally, the population of Japanese nationals was 122.78
million—a decrease of 618,000 (-0.50%) from the previous
year—and the rate of decline has been increasing for 10
consecutive years.
By 2025, the population of older adults, especially those

Corresponding author: TANEDA Kenichiro
2-3-6 Minami, Wako, Saitama 351-0197, Japan.
Tel: 048-458-6150
Fax: 048-469-2768
E-mail: taneda.k.aa@niph.go.jp

J. Natl. Inst. Public Health, 72 (1) : 2023

43

TANEDA Kenichiro, KAKINUMA Tomohiro, NAKANISHI Yasuhiro, KOBAYASHI Kenichi, AKAHANE Manabu
Rapid increase in older adults (old-old)（Of which, 75 years onwards)
65 years onwards

15-64 years old

(901)
2,204

（＋81.1%）＋53.7%

8,638(Units: Tens of thousands of people)（＋33.6%）(1,632)
3,387＋ 8.6%

7,728▲ 7.2%▲10.5%(2,180)
3,677

7,170

（＋ 2.7%）＋ 6.6%▲16.6%(2,239)
3,921

5,978

Rapid decrease in working-age population
0-14 years old

1,851

1,595

1,407

2000

2015

2025

（Results）（Results）
All baby boomers
are over 65 years
old（Estimation）

All baby boomers
are over 75 years
old

1,194
2040

（Estimation）
All secondgeneration baby
boomers are over
65 years old

Figure 1 Changes in Demographics – Demographic Structure(Source) Ministry of Internal Affairs and Communications "Population Census" and "Population Estimates," National Institute of Population and Social Security Research "Population Projections forJapan, 2017 Estimates"

aged 75 and over, will rapidly increase and then slow down,
but the population aged 65 and over is estimated to continue increasing until around 2040 and peak. In contrast, it isestimated that the decline of working-age population will
accelerate from 2025 onward (Figure 1).
Consequently, Japan’s future medical care context will not
only witness an increase in medical demand in certain regions because of increase in the population of older adults,
but also reduced medical demand in regions where theolder adult population will not increase, demonstrating howchanges in medical needs due to declining birth rate/aging
population and changes in disease structure will vary by region, and that a uniform response will be difficult to achieve.
Furthermore, owing to the shortage of medical personnel, it
is necessary to allocate medical resources more efficiently
and build an efficient medical service system.
Given these circumstances, the Ministry of Health, Labour and Welfare has stated that it is necessary to promote
the following three initiatives in an integrated manner asreforms that look toward the medical service system in
FY2040:
1. Optimal placement and cooperation of medical facilities(Realization of the Community Health Care Vision: By
FY2025) [2]①Form a consensus on the specific response policies
among all public medical institutions.
②Verification of specific response policies and further
efforts toward realization of the Community HealthCare Vision.
2. Work style reform of doctors and medical staff (Upper
limits on doctors’ overtime work: From FY2024) [3]44①Optimization of working hours management andmanagement reform in medical institutions.
②Dissemination and enlightenment for good medicalcare and support for patients and families.
3. Effective measures against uneven distribution of doctors (Target year for correction of uneven distribution:
FY2036)①Measures against uneven distribution of doctors between regions and clinical departments.
②Responding to primary care needs such as securing
general practitioners.
The first initiative of the Community Health Care Vision
will be discussed in greater detail below. In a 2013 report by
the National Council on Social Security Systems [4], a government panel of experts tasked with examining the futureof social security described the following key requirement:“Prefectures need to formulate their own Community
Health Care Vision indicating how much medical care isneeded for each medical care function, which is appropriate
and balanced for each of its regions, based on predictionsof their respective future medical needs made based on
objective data.” Subsequently, the Medical Care Act wasamended in response to the 2014 “Draft Act on Amendatory Law to the Related Acts for Securing Comprehensive
Medical and Long Term Care in the Community” to require
prefectures to formulate a Community Health care “vision”(i.e., ideal future implementation of their regional medical
service system) in their Medical Care Plans based on thisprovision. In March 2017, a Community Health Care Vision
was established in every prefecture. To realize the firstinitiative of the Community Health Care Vision by FY2025,

J. Natl. Inst. Public Health, 72 (1) : 2023

Community Health Care Vision: Toward realizing the desired medical service system
it is necessary to form a consensus within the community
regarding specific response policies, including public andprivate medical institutions. As for the second work-stylereform for doctors and medical staff, upper limits on working hours for doctors are expected to be implemented starting FY2024. The third initiative, namely effective measures
to correct the uneven distribution of doctors by FY2036,
is seeing efforts to correct the uneven distribution of doctors between regions and clinical departments, as well as
response to primary care needs, such as securing generalpractitioners.

II. What is the Community Health Care Vision?
In Japan, every prefecture is mandated to create a “Medical Care Plan” based on the Medical Care Act in order tobuild effective and efficient medical service systems in its
constituent regions (Article 30-4, Paragraph 1). Such plansinclude many components—promoting information provision on hospital bed functions and healthcare frameworks
for different diseases and projects; securing physicians,
other healthcare personnel, patient safety, and systems fordelivering outpatient care; and specifying secondary/tertiary medical care zones, development goals for healthcare
facilities, areas with abundances/shortages of physicians,
and standard numbers of hospital beds—but one of the mostimportant is realizing the Community Health Care Vision.
To build an efficient system to provide high-quality medical care in the context of changes in the quality and quantityof medical needs and a decline in the labor force due to theabove-mentioned population decline and aging, it is necessary to differentiate the functions of medical institutions
and encourage collaboration between them. The Community Health Care Vision is the idea formulated to estimate themedical demand and number of beds required in FY2025 bymedical care function (advanced acute phase, acute phase,convalescence phase, and chronic phase) in each region topromote such differentiation and cooperation of medical
institutions. Here, the current situation and future directionof each medical institution are “visualized” through “BedFunction Reports,” and the “Community Health Care Vision Coordination Committee” set up in each vision area (theregional unit tasked with hospital bed provision) holds discussions on the functional differentiation and coordinationof hospital beds.
The Bed Function Report System is a system for each
medical institution (including clinics with beds) to report tothe prefectural government the “Current status” and “Future direction” of its choice of medical function in units of
hospital beds every year. There are four medical functions
to choose from: advanced acute phase, acute phase, conva-

lescence phase, and chronic phase, which are each defined
as follows:⃝Advanced acute phase function: A function of providing medical care where the density of medical care isespecially high to patients at the acute phase to stabilize the condition of those patients early. Examples ofwards that may be regarded as handling advanced acutefunctions include wards where the density of medicalcare is particularly high for acute phase patients, suchas critical care wards, intensive care units, high careunits, neonatal intensive care units, neonatal convalescence units, pediatric intensive care units, and generalperinatal intensive care units.
⃝Acute phase function: A function of providing medicalcare to patients at the acute phase to stabilize theircondition early.
⃝Convalescence phase function: A function of providing
medical care or rehabilitation to patients who haveproceeded from the acute phase. In particular, this includes a function of intensively providing rehabilitation(convalescence phase rehabilitation function) for the
purpose of improving ADL with the goal of returninghome for those patients with such diseases as cerebrovascular diseases or femoral neck fractures who haveproceeded from the acute phase.
⃝Chronic phase function: A function of hospitalizing
patients who require medical treatment over a long
period. It is a function to hospitalize severely disabled
persons (including persons with severely disturbed
consciousness), patients with muscular dystrophy, or
patients with intractable diseases, who require medical
treatment over a long period of time.
The most recent Bed Function Report (FY2021) is shownin Figure 2. The graph shown on the very right is an estimation (as of the end of FY2016) of the medical demandin FY2025 calculated as the number of beds required in
FY2025 according to the Community Health Care Vision,
based on the hospitalization rate and projected population.
The number of hospital beds was expected to decrease
by approximately 40,000 to 1.21 million in FY2021 fromapproximately 1.25 million in FY2015. In the FY2021 Bed
Function Report, the number of beds reported by each
medical institution as “scheduled bed functions as of July 1,2025” is expected to reach approximately 1.2 million beds
in FY2025. Looking by bed function, compared to the required number of beds in FY2025 on the far right, there are
more in the advanced acute phase, acute phase, and chronic
phase, and less in the convalescence phase. Therefore, regional medical institutions are expected to hold discussions
at the Community Health Care Vision Coordination Meeting and voluntarily proceed with functional differentiation

J. Natl. Inst. Public Health, 72 (1) : 2023

45

TANEDA Kenichiro, KAKINUMA Tomohiro, NAKANISHI Yasuhiro, KOBAYASHI Kenichi, AKAHANE Manabu(Each medical institution reports by ward unit)(Each medical institution
reports by ward unit)

FY2015
Total: 1.251 million beds

Number of hospital beds required in
2025 according to the Community
Health Care Vision

FY2021 Bed Function Report

FY2015 Bed Function Report

FY2021

Total: 1.21 million beds

Reduction by approx.
9,000 beds

FY2025 estimate
Total: 1.201 million beds

Total: 1.191 million beds

Advanced acute

169,000 beds (14%)

Advanced acute

Reduction by
14,000 beds

155,000 beds (13%)

765,000 beds

895,000 beds

Acute897,000 beds

596,000 beds (48%)

Convalescence

Chronic

355,000 beds (28%)

Advanced acute

Acute901,000 beds

549,000 beds (45%)

1.33

Convalescence
193,000 beds (16%)

Reduction by
43,000 beds

312,000 beds (26%)

Chronic

131,000 beds (11%)

696,000
beds
Acute

Acute

532,000
beds

401,000 beds (34%)

536,000 beds (45%)

Reduction by
13,000 beds

Increase by
63,000 beds

Advanced acute160,000 beds (13%)

705,000 beds

Reduction by
47,000 beds

130,000 beds (10%)

Increase by
4,000 beds

907,000
beds
Convalescence

Increase by
13,000 beds

206,000 beds (17%)

Reduction by
13,000 beds

299,000 beds (25%)

Chronic

５

Convalescence
375,000 beds (31%)

Chronic
284,000 beds (24%)

Figure 2 Bed Function Report
Source: FY2021 Bed Function Reportand cooperation. Presently, prefectures utilize the “Fundfor Medical and Long-Term Care” to support the functional
differentiation and coordination of medical institutions, andto subsidize the improvement of facilities and equipment
associated with the conversion of hospital bed functions.
However, if the differentiation and cooperation of functions
do not progress, it is also required that prefectural governors
appropriately exercise their role stipulated in the Medical
Care Act; the following items are listed as specific authority:[Prefectural authority stipulated in the Medical Care Act]
①Orders (public medical institutions, etc.) and requests/
recommendations (private medical institutions) to stop
conversion of medical institutions attempting to convert to medical facilities that are already in excess in
the region.
②Instructions (public medical institutions, etc.) and requests/recommendations (private medical institutions)to assume medical functions that are lacking in theregion in cases when consultations are unsuccessful.
③If there is an application for permission to open a hospital, etc., conditions are attached to the permission
for opening, etc. so that the hospital fulfills the medical
functions lacking in the region.
④Orders (public medical institutions, etc.) and requests/
recommendations (private medical institutions) to reduce the number of unused hospital beds.

III. Community Health Care Vision Coordination Meeting
The Community Health Care Vision Coordination Meet-46

ing is a forum for consultation as stipulated in the Medical
Care Act, and is stipulated as follows:
The Medical Care Act Article 30-14: 1) The prefecture
is to establish a place for consultation with organizationsof academic experts on medical treatment, other medical
experts, medical insurers, and other related parties, andin cooperation with related parties, hold consultations on
measures to achieve the future requirements for the number of beds specified in the Medical Care Plan and otherparticulars necessary to promote the achievement of theCommunity Health Care Vision. 2) When related parties arerequested by the prefecture to participate in a consultation
conducted by the prefecture pursuant to the provisions of
the preceding paragraph, they are to endeavor to cooperateby participating, and must also endeavor to cooperate in
the implementation of particulars that related parties haveagreed upon at the place of such consultation.
As specific matters for discussion, the following items
were stipulated regarding responses to specific response
policy decisions for individual medical institutions:○Each fiscal year, prefectures should compile a specificresponse policy that was agreed upon at the Community Health Care Vision Coordination Meeting. The
following content should be included in the compilationof the specific response policy:①Role as a medical institution that should be playedin the vision area looking ahead to FY2025②Number of hospital beds for each medical function
in FY2025⃝Public hospitals, public medical institutions, etc. should
formulate the “New Public Hospital Reform Plan” andJ. Natl. Inst. Public Health, 72 (1) : 2023

Community Health Care Vision: Toward realizing the desired medical service system“Public Medical Institutions FY2025 Plan” and discussthem during FY2017.
⃝Among other medical institutions, those hospitals thatwill significantly change their role should formulate afuture business plan and promptly consult.
⃝Medical institutions other than the above should be
consulted by the end of FY2018 at the latest.
It has been indicated that it will take a lot of time to coordinate the reorganization of hospital bed functions because
there are so many stakeholders involved in the Community
Health Care Vision and each stakeholder has different priorities. In fact, by March 2017, all prefectures had formulated
Community Health Care Visions. In September 2019, theclinical performance data of public medical institutions was
published by the “Working Group on Community HealthCare Vision (WG)” of the Health Policy Bureau, Ministryof Health, Labour and Welfare because of the need for
re-validation of the Visions formulated by the prefectures.
However, various critical opinions were expressed against
this, and the Ministry of Health, Labour and Welfare was
required to respond by holding individual meetings to exchange opinions one after the other in response to requests
from prefectures, and set up multiple forums for national
and local consultations on securing regional medical care.
In January 2020, the Director-General of the Health Policy Bureau issued a notice titled “Regarding re-validationof specific response policies for public medical institutions,etc.” to prefectures, and together with this, provided the“Analytical results of clinical practice data from public medical institutions, etc.,” and clinical practice data from private
medical institutions. Additionally, the Covid-19 pandemic
broke out while work was in progress to further promote

Normal times

efforts by selecting priority support areas (i.e., areas receiving financial and technical aid from the national government at a prefecture’s request), forcing medical institutions
nationwide to respond to the outbreak and making it difficult to promote the Community Health Care Vision. The
pandemic necessitated securing manpower by temporarilyceasing the operation of general beds and long-term carebeds; converting a certain number of beds to COVID-19 infection beds; and temporarily increasing the number of beds
to respond to increasing patient demand (Figure 3).
In December 2020, the “Study Group on Reviewing Medical Care Plans” of the Health Policy Bureau of the Ministryof Health, Labour and Welfare held a meeting to discuss the
Vision and how to proceed, including “Ideas toward building
a future medical service system in light of the COVID-19
pandemic.” Specifically, “Medical care at the time of spreadof infection such as emerging infectious diseases” is added to the description of Medical Care Plan such that theconventional “Five tasks” (emergency medicine, disastermedicine, remote area medicine, perinatal medicine, andpediatric medicine including pediatric emergency medicine)increase to “Six tasks.” It was decided that in the future,
the Ministry of Health, Labour and Welfare will conduct
a detailed review of the contents of the plan (measures,
initiatives, numerical targets, etc.), and will review the“Basic Policy” (Minister’s Notification) and “Medical Care
Plan Preparation Guidelines” (Director-General’s Notification), after which each prefecture would formulate plansby adding a response to the spread of infection from the 8th
Medical Care Plan (FY2024–FY2029). Although COVID-19
measures continue, the medium- to long-term situation andoutlook that form the background of the Community HealthCare Vision have not changed. In other words, the popula-

Response in the early stageof the pandemic

Response during the
pandemic(Response to short-term medical demandassociated with the pandemic)
Recoveryaccommodation facilities
Temporary medical
facility

Temporary suspensionof active beds

Temporary increase
in beds(Securing manpower)

Beds for infectious
diseaseBeds for infectious
diseaseManpoweruse

Beds for infectious
diseaseTemporary suspensionof active beds
・Securing manpower

Generalbeds&
Long-termcare beds

Conversion to a
bed for receiving
infected patients(zoning, etc.)

・Infection control
measures (zoning, etc.)

Manpoweruse

General beds&
Long-termcare beds

Document 6, the 28th Community Health Care Vision Working Group (November 5, 2020)

Figure 3 System for patient acceptance during the Covid-19 pandemic (image)J. Natl. Inst. Public Health, 72 (1) : 2023

47

TANEDA Kenichiro, KAKINUMA Tomohiro, NAKANISHI Yasuhiro, KOBAYASHI Kenichi, AKAHANE Manabu
tion is steadily declining and aging, the quality and quantityof medical needs are gradually changing, and manpower
constraints are becoming more severe. As such, to maintaina high-quality and efficient medical service system in eachregion, efforts to differentiate and coordinate medical functions were deemed essential. Based on the premise that the
short-term medical demand during the spread of infection
will be dealt with flexibly based on the “Medical Care Plan”
of each prefecture, it was decided to promote the initiatives
while maintaining the basic framework of the Community
Health Care Vision (estimation of the required number ofhospital beds/ideas, etc.).
In March 2021, the Director-General of the Health Policy Bureau issued a notice titled “How to proceed with theCommunity Health Care Vision,” and the basic idea was
as follows: “In the future, when the 8th Medical Care Plan
(FY2024–FY2029) is to be formulated in each prefecture
until FY2023, each region will have to conduct studies toward adding items to be described (response to emerging
infectious diseases) and discuss the functional differentiation of hospital beds and collaboration. The response policies of each medical institution, including private medical
institutions associated with the Community Health Care
Vision in FY2022 and FY2023 should be formulated and validated/reviewed as well. In doing so, the fact that the spreadof Covid-19 has reaffirmed the significance of functional
differentiation and coordination of hospital beds in each prefecture should be considered.” Furthermore, regarding the
publication of the status of discussions, it was indicated that
“The status of deliberations will be made public on a regular basis. Specifically, in FY2022, the Ministry of Health,Labour and Welfare will monitor the status of ‘agreed andverified,’ ‘under consultation and verification,’ and ‘notstarted consultation and verification’ as of the end of September 2022 and the end of March 2023. Additionally, eachprefecture will publish the content of the report on its website, etc.” All medical institutions, including private medical
institutions, are required to formulate a response policy for
FY2025.

IV. Initiatives toward realizing the Community Health Care Vision (general picture)
The Ministry of Health, Labour and Welfare will provide
support according to local needs through the following initiatives:
1) Technical support for stimulating discussion①Provision of data and information
・Bed function reports, etc.
・Specific examples such as priority support areas②Hosting of workshops, etc.

48

・Health policy workshops (for prefectural government staff)・Community Health Care Vision Advisory Meeting・Top management workshop (for hospital administrators)③Support according to the needs of the region/medical
institution
・Implementing needs-based technical support (dataanalysis, etc.) for “priority support areas” selectedby the national government based on requests at theprefectural level* In the future, detailed support will be provided in response to requests from prefectures to further revitalize local consultations
・S upport for data analysis based on consultations
within the prefecture (within the area)
・Support for holding briefings, etc. for medical institutions, chiefs, and residents in the prefecture (within the area)
2) Financial support, etc. for efforts to reorganize hospital
bed functions
Based on the agreement at the Community Health Care
Vision Coordination Meeting, the following financial support will be provided for efforts to reorganize hospital bed
functions・Financial support for the development of facilities
and equipment necessary for the reorganization of
hospital bed functions and financial support for dealing with various issues associated with the decreasein hospital beds (hospital bed function reorganization
support project) are provided by the Fund for Medical and Long-Term Care・Generous financial support (addition of hospital bed
function reorganization support project) is provided
for “priority support areas” selected by the national
government based on requests at the prefectural level・Implementation of preferential tax treatment (registration and license tax) for real estate acquired basedon the “reorganization plan” approved by the Minister
At the regional level, with the support of the Ministryof Health, Labour and Welfare: 1) Regular hosting of Community Health Care Vision Coordination Meetings (at thelevel of vision areas, at the prefectural level), 2) Provisionof Bed Function Reports, etc., and 3) Revitalization of discussions by Community Health Care Vision advisors will be
performed for revitalization of discussions at the prefecturallevel. Furthermore, stimulating discussions at Community
Health Care Vision Coordination Meetings will promote: 1)
understanding and sharing of regional medical needs andmedical functions, 2) determining the direction of efforts
at individual medical institutions, and 3) utilization of “pri-J. Natl. Inst. Public Health, 72 (1) : 2023

Community Health Care Vision: Toward realizing the desired medical service system
ority support areas” and “reorganization plan,” etc. Consequently, initiatives based on specific hospital bed function
reorganization agreements have been materialized, and it isexpected that studies will be conducted on bed function reorganization in multiple medical institutions using technicalsupport, etc. of ① “Priority support areas” and initiatives
using the ② Fund for Medical and Long-Term Care (including hospital bed function reorganization support projects)
and tax incentives.
Furthermore, the upcoming reversal of Japan’s demographic aging, with the elderly population predicted topeak around 2040 and subsequently decline, was brought
up at the “21st Study Group on the 8th Medical Care Plan,etc.” held in December 2022. With this trend in mind, theMinistry of Health, Labour and Welfare stated that from2025 onward, it will be necessary to update and re-organize
medium- and long-term issues, including ones that became
strikingly apparent due to the coronavirus pandemic, andformulate new Community Health Care Visions. For thesereasons, they committed to examining and specifying issues
relevant to the formulation of new Community Health Care
Visions while continuing with current initiatives.

V. Efforts at the National Institute of Public
Health [5]Since 2019, the National Institute of Public Health—a Research and Development institute of the Ministry of
Health, Labour and Welfare—has been conducting “TopManagement Training (for hospital administrators),” which
is one of the initiatives of the Ministry of Health, Labourand Welfare. To implement effective training, interviews
were conducted with local governments and medical institutions that have actually worked on the reorganizationand integration of medical institutions (local social and geographical background, reasons and background for hospitalreorganization and integration, relationship with the university hospital responsible for dispatching doctors, status
and issues of functional differentiation and cooperation withsurrounding medical institutions, treatment of staff whenreorganizing and integrating, etc.) to reflect these in the
training.
The trainees include hospital executives or hospitaladministrators of medical institutions that play a central
role in regional medical care recommended by prefectural governments. Considering the busy schedule of the
trainees, two-day workshops were conducted for up to 50
people to facilitate their participation. However, owing to
the COVID-19 pandemic, it has become difficult to hold onsite training, and therefore, from FY2020 onward, two-day
online workshops have been conducted—half-a-day each—for up to 30 participants. Roughly 250 people participated inthese workshops in the four years from FY2019 to FY2022,
including attendees not only from public hospitals but alsoprivate and university hospitals. The goals of the training
workshops are as follows:[Goals] To acquire knowledge and skills related to hospital management, such as the medical system, hospital reorganization/integration, data analysis, and human resource
management, to advance the differentiation and collaboration of medical functions based on the Community HealthCare Vision:
1. To be able to explain trends in the Community HealthCare Vision and related healthcare policies.
2. To be able to explain the data analysis method for promoting the Community Health Care Vision.
3. To explain the ways to study the reorganization andintegration of medical institutions.
Most recently, workshops were held on January 24 (Tuesday) and 25 (Wednesday) 2023 according to the below-mentioned schedule:[Workshop schedule]
Day 1
13:00-13:10 (10 minutes) Welcoming ceremony/orientation
13:10-14:00 (50 minutes) (Exercises) Group work based on
pre-arranged assignment
14:00-14:10 (10 minutes) Break
14:10-14:40 (30 minutes) (Pre-viewing and question-and-answer session of the lecture) Current status of the Community Health Care Vision
14:40-14:50 (10 minutes) Break
14:50-17:00 (130 minutes) (Case study) Reorganization andintegration of medical institutions (10-minute break in between)
Day 2
13:00-14:00 (60 minutes) (Lecture) Method of data analysis
for the Community Health Care Vision
14:00-14:10 (10 minutes) Break
14:10-15:10 (60 minutes) (Lecture) Process of realizing theCommunity Health Care Vision in Nanwa area, Nara prefecture
15:10-15:20 (10 minutes) Break
15:20-15:40 (20 minutes) (Pre-viewing and question-and-answer session of the lecture) Work style reform for doctors
15:40-16:20 (40 minutes) (Lecture) Case reports on workstyle reform for doctors (from two hospitals)
16:20-16:30 (10 minutes) Break
16:30-17:20 (50 minutes) (Exercise) Workgroup on problem-solving
17:20-17:30 (10 minutes) Closing address
To make the training effective in a limited period, participants (1) watched and listened to pre-recorded lectures

J. Natl. Inst. Public Health, 72 (1) : 2023

49

TANEDA Kenichiro, KAKINUMA Tomohiro, NAKANISHI Yasuhiro, KOBAYASHI Kenichi, AKAHANE Manabu
from the Ministry of Health, Labour and Welfare officials(one about Community Health Care Vision, another about
work style reform of doctors, lasting approximately 30
minutes and 20 minutes, respectively) and focused on thequestion-and-answer session on the day of the workshop, 2)
exchanged opinions employing the case method, using actual cases as teaching materials, and (3) submitted problems
faced in their own medical institutions in advance, and summarized hints for solving the problems through lectures andopinion exchanges in small groups (four people per group)
during training. In the response to the post-workshop questionnaire of the most recent training workshop, 15 out of
32 participants (approximately 47%) responded that theiroverall level of satisfaction with the training workshop
was “Generally good,” and 15 others (approximately 47%)
mentioned that it was “Very good.” Even in the free comments section, there were many positive comments about
the workshop, including “The workshop itself provided anenvironment that facilitated discussion, and raised my levelof understanding,” “The content of the lecture was a reference for current hospital issues without anything missing,”“I had opportunities to exchange opinions with people inareas and hospitals that I had no daily contact with before,
and I learned a lot about the situation,” “I underwent training on the Community Health Care Vision and work stylereforms for doctors, which are common issues for medical
institutions, using case studies,” “The training workshops
increased my motivation,” and “The workshop broadened
my horizons.” These comments suggested that the training
at the National Institute of Public Health contributed to thespecific efforts of each medical institution responsible forbuilding a sustainable medical service system in the region/community.

VI. Conclusion
Responding to changes in the demographic structure in
anticipation of FY2040, specifically maintaining medical
functions in areas with a declining population, securing
manpower, and reforming the workstyle of doctors to re-50

spond to the declining working-age population, including
medical workers, is the urgent issue that merits attention.
Additionally, the changes in inpatient/outpatient medical
needs, collaboration between medical care and long-termcare, and the need to respond to increase in regional endof-life care due to super-aging society and rapid decline in
population have been highlighted. In fact, the COVID-19
outbreak has reaffirmed the significance of division of rolesand cooperation among medical institutions that support
regional medical care, including strengthening outpatientcare and home care by teams. It is hoped that the Community Health Care Vision Coordination Meeting will serve as
an opportunity to consider these issues in the region andcontribute to the building of a sustainable medical service
system in each region/community, considering the situationof each region/community.

Reference[1] 総務省統計局．全国人口．
Statistics Bureau of Japan. [Total population.] https://www.
stat.go.jp/data/jinsui/2021np/pdf/2021gaiyou.pdf (in Japanese)(accessed 2023-01-20)[2] 厚生労働省．地域医療構想．
Ministry of Health, Labour and Welfare. [Regional medicalcare vision.] https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000080850.html (in Japanese)(accessed 2023-0120)[3] Taneda K. Labor reforms for physicians in Japan. J Natl Inst
Public Health. 2021;70(1):54-60.
[4] 内閣府．社会保障制度改革国民会議報告書．
Cabinet Office. [Report by the National Council on Social
Security Systems.] https://www5.cao.go.jp/keizai-shimon/
kaigi/minutes/2013/0808/sankou_02.pdf (in Japanese)(accessed 2023-01-20)[5] The National Institute of Public Health. https://www.niph.
go.jp/en/index/ (accessed 2023-01-20)

J. Natl. Inst. Public Health, 72 (1) : 2023

Community Health Care Vision: Toward realizing the desired medical service system＜総説＞
地域医療構想―目指すべき医療提供体制を実現するために―
種田憲一郎 1），柿沼倫弘 2），中西康裕 2），小林健一 2），赤羽学 2）1）

国立保健医療科学院国際協力研究部

2）

国立保健医療科学院医療・福祉サービス研究部

抄録
本邦における人口構造の変化，具体的には少子高齢化，医療者を含む労働者人口の減少を踏まえて，効率的な医療提供体制を構築することが喫緊の課題となっており，医療機関の機能分化・連携を進めていく必要がある．これを推進するために各地域における2025年の医療需要と病床の必要量について，医療機能（高度急性期・急性期・回復期・慢性期）ごとに推計し，策定されるのが「地域医療構想」である．2017年には全ての都道府県において地域医療構想が策定され取組みが始まったが，
2020
年の新型コロナウイルスによる感染拡大により，医療機関は患者対応に追われた．同年12月に厚生労働省医政局「医療計画の見直し等に関する検討会」において，構想の考え方・進め方の議論を含めた「新型コロナウイルス感染症を踏まえた今後の医療提供体制の構築に向けた考え方」がとりまとめられた．2021年 3 月には，医政局長通知「地域医療構想の進め方について」が発出され，「今回の新型コロナウイルス感染症の感染拡大により病床の機能分化・連携等の重要性が改めて認識された」として，2040年の医療提供体制を見据えた 3 つの改革（医療施設の最適配置の実現と連携，医師・医療従事者の働き方改革，実効性のある医師偏在対策）の 1 つとして，継続した取組みが進められている．
キーワード：地域医療構想，人口構造，地域医療構想調整会議，病床機能報告，研修

J. Natl. Inst. Public Health, 72 (1) : 2023

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