Exclusive: Kichijoji Medical System Clash as New Hospital Plan Meets Strong Resistance

Surrounding hospitals voice concerns about too many hospital beds

Tokyo’s Kichijoji, a district that consistently ranks among the most desirable places to live. In this popular area—where refined streetscapes coexist with rich natural surroundings—a problem has arisen that now threatens to shape the future of local healthcare.

The issue began in October 2024. Kichijoji Minami Hospital, the only secondary emergency medical facility in the area (a hospital that accepts severe patients requiring hospitalization or surgery around the clock), suspended its services due to aging facilities.

Even before this, the area had seen a series of hospital closures and reductions in emergency care functions. Combined with the shutdown of Kichijoji Minami Hospital, more than 330 beds have been lost over the past ten years. As a result, a serious gap has emerged in the region’s emergency medical system.

Details were reported in the July 28, 2024 edition of “FRIDAY DIGITAL”:

Kichijoji, the “No. 1 Town to Live in,” has become a difficult place to live for the elderly. The reality of the medical collapse crisis that is sweeping through Kichijoji, the “No. 1 Town to Live in.”

In this situation, a plan emerged: in March 2025, the medical corporation Tokyo Kyoju no Kai would take over operations and build a new 300-bed hospital. Musashino City also indicated support, and it seemed the issue might move toward resolution. However, strong objections were raised by existing hospitals in and around Musashino City. The expectations of residents and the concerns of established medical institutions—what exactly is happening in Kichijoji?

The debate intensified at the September 18, 2025 meeting of the “Northern Tama South Medical Zone Regional Healthcare Vision Coordination Council,” which discusses the division of roles among local hospitals and the number of beds. Because strong concerns had been voiced by nearby hospitals regarding the new hospital plan, a special session dedicated to the issue was convened.

At that meeting, serious concerns were expressed about the scale and necessity of the planned new hospital. A representative from one hospital presented regional medical data and stated the following:

“The number of required beds calculated by the Tokyo Metropolitan Government is based on data from before 2013 and does not reflect current conditions. Due to shorter hospital stays, bed occupancy rates have declined in many hospitals, and from an on-the-ground perspective, far fewer beds are needed. In reality, after Kichijoji Minami Hospital suspended services, other medical institutions in the area have already absorbed its emergency load.”

They also referred to future population projections:

“The population aged 85 and older in this area will peak in 2035 and then begin to decline. The number of beds needed will decrease accordingly. We should consider this cautiously with an eye toward the future.”

The representative warned that the new hospital could lead to an oversupply of beds in the region.

Another hospital official voiced concern about the impact on management:

“This plan may further strain existing hospitals already facing financial difficulties, triggering competition and uneven distribution of healthcare workers such as nurses, and exacerbating staff shortages. The negative impact on this medical zone would be significant.”

The debate also extended to the emergency medical functions expected of the new hospital in the event of a disaster.

“You can just rely on the hospitals in neighboring Mitaka City.”

Musashino City has divided the city area into three areas, each of which has a disaster base hospital or a disaster base hospital. With the closure of Kichijoji Minami Hospital, the eastern area of Musashino City is now left without a disaster base. The city sees this situation as a challenge and hopes that the new hospital will take on this role.

In contrast, opinions from different perspectives were expressed at the coordination meeting. One representative cited examples of training in other cities,

One representative, citing examples of drills in other cities, suggested that in the early stages of a large-scale disaster, it is easier to function if medical resources are consolidated than if they are dispersed unnecessarily.

Musashino City has divided its territory into three areas, assigning each either a disaster base hospital or a disaster-base–affiliated hospital. With the suspension of Kichijoji Minami Hospital, the eastern district of the city now has no disaster-response base. The city views this as a major issue and hopes the new hospital will assume that role.

In contrast, the Coordination Council presented a different viewpoint. One representative, citing training examples from other municipalities, argued:

“In the initial stage of a large-scale disaster, it is more effective to consolidate medical resources than to disperse them unnecessarily.”

They continued:

“Disaster response should be considered on a broader regional basis, not at the level of individual municipalities. In the neighboring Mitaka City, there is Nomura Hospital, which is a disaster-base–affiliated hospital. If a cooperative framework is established across municipalities, the situation can be handled.”

They suggested that residents of the Kichijoji area could rely on hospitals in adjacent Mitaka City during a disaster, questioning the need for the new hospital to have disaster-base functions.

Meanwhile, Musashino City and local residents strongly desire the early reopening of an emergency hospital. To support the plan, the city decided to relocate a community center adjacent to the proposed construction site and provide the land. At a community briefing session, most residents in attendance reportedly expressed support for the construction.

Dr. Masamichi Fujii, former director of Kichijoji Minami Hospital and now involved in the new hospital project, criticized the Coordination Council’s discussion as lacking the viewpoint of patients’ daily lives. Regarding the debate on disaster-base functions, he said the importance of location was being overlooked:

“The planned site for the new hospital faces a designated emergency transport route—roads where emergency vehicle passage is given top priority during disasters. It is also close to the downtown area, making it easy to bring in injured people from there. It is an ideal location for an initial medical response hub during a disaster. Wide-area cooperation is of course important, but the value of having a base close to disaster sites with secure access routes is immeasurable.”

He further emphasized the importance of time in everyday emergency care:

“The essence of emergency medical care is not just saving lives—it is helping patients return to their normal lives without lasting aftereffects. For example, in stroke cases, the brain suffers irrecoverable damage in just five minutes without oxygen. The Council’s argument that ‘there are other hospitals that can take patients’ may imply that transporting someone for 30 minutes is acceptable as long as they eventually reach a hospital. But it is crucial to consider how that 30 minutes can affect a patient’s long-term outcome. Medical care should be evaluated based on whether the patient is able to return to society.”

He also spoke further about the hospital management necessary to sustain emergency medical services, and the growing importance of rehabilitation in an aging society.

Medical care from emergency to rehabilitation

“In the current medical reimbursement system, acute-phase care such as emergency medicine becomes less profitable the longer a patient stays hospitalized. Therefore, for a hospital to continue accepting emergency patients, it is essential to have a ‘recovery-phase ward’ that accepts patients once they are past the acute stage and supports their return home through intensive rehabilitation. The high-quality rehabilitation provided there greatly affects patients’ quality of life afterward—for example, enabling them to return home without increasing their level of nursing care needed.

And to deliver such high-quality rehabilitation, a multidisciplinary team of specialists—physical therapists, occupational therapists, and speech-language pathologists—is necessary. To secure enough of these specialized staff and to operate effective programs, a sufficient number of hospital beds is required. Offsetting the deficits of emergency care with recovery-phase revenue and running the hospital sustainably as a whole—this dual structure must function. For that reason, a scale of 300 beds is no longer a luxury; it is an essential condition for taking responsibility for emergency medical care in the region.”

A medical correspondent for a business magazine analyzes the issue as:

“An example of the structural problems many regions are facing.”

“Hospital buildings nationwide are aging, but rebuilding is financially difficult given the harsh management environment. Even if we preserve existing hospitals now, they may eventually face a crisis of survival. The entry of a new hospital may appear threatening to existing institutions, but from the perspective of maintaining high-quality healthcare across the entire region, some degree of renewal is sometimes necessary.

While the world of healthcare—where human lives are entrusted—cannot operate solely on simple market principles, there is also the reality that if it cannot respond to changes in the times and the needs of residents, local healthcare itself will become unsustainable. How should we protect the existing healthcare system, and how should we carry it into the future? The medical field is standing at a major crossroads.”

The debate surrounding the reopening of Kichijoji’s emergency hospital highlights two crucial themes for the community: securing the medical services residents need, and ensuring the sustainability of the region’s overall healthcare system.