Kana Watanabe

In a country like Japan, where the welfare system is famously well-organized and comprehensive, one might find it difficult to imagine that healthcare inequity exists. However, the current state of healthcare in rural Japan—regions outside major metropolitan areas like Tokyo—reveals a different story. Healthcare access is increasingly uneven, and disparities continue to widen.

“Local Hospitals Will Disappear”

The number of medical institution bankruptcies in 2024 has nearly doubled compared to 2023, signaling a deepening crisis in rural healthcare. As small hospitals and clinics continue to shut down due to financial constraints, patients in remote areas—especially the elderly—are left without access to essential medical services. Hospital consolidation and closures have become increasingly common, and experts warn that many regions outside Tokyo may face a total collapse of healthcare infrastructure within five years.

Emergency medical care is particularly at risk. Facilities once capable of handling urgent needs are shutting down, leaving residents with few or no options for immediate care. Obstetric and pediatric services have been hit hard, with small- and medium-sized facilities closing down due to a lack of funding and staff. Compounding the issue, many practicing doctors in rural regions are reaching retirement age and may not be up to date with the latest medical technologies and practices, further reducing the quality of care.

Consequences for Vulnerable Populations

This healthcare decline disproportionately affects the most vulnerable populations —elderly residents, pregnant women, children, and those with chronic illnesses. In aging rural communities, older adults may not have the mobility or resources to travel long distances to urban centers for treatment. Without nearby clinics or emergency services, a simple illness or injury can become life-threatening.

Expectant mothers in rural areas are increasingly forced to travel hours to find a hospital that offers obstetric care. This not only increases health risks for both mother and child but also places emotional and financial burdens on families. Meanwhile, the closure of pediatric units limits access to early intervention and preventive care for children, potentially leading to long-term health issues that could have been mitigated with timely treatment.

This crisis is not just about infrastructure—it is a matter of life and death. The government’s ability to intervene in time will determine whether these rural communities survive or continue to hollow out, both medically and demographically. This puts further stress on rural communities that are already suffering from the declining birthrate and increasingly aging population. 

Current Policy Efforts to Address Rural Healthcare Inequity

In response to growing healthcare disparities in rural areas, Japan has implemented policy efforts with objectives to address healthcare inequity in rural areas. A key initiative that has been taken was to shift the financial responsibility of national health insurance from municipalities to prefectures, which help to ensure more consistent funding in rural regions with declining and aging populations. 

The Japanese government has also increased support for home-based care through Home Care Support Clinics. The program provides 24/7 physician visits, which are crucial in rural areas that lack large hospitals or even clinics. Additionally, to address the workforce shortages, Japan is expanding telehealth services. Regulatory reforms that began in 2015 (which further expanded during and after the COVID-19 pandemic) have allowed patients to receive consultations remotely. In 2024, Japan’s telehealth market expanded significantly, reaching over 1 billion, and is expected to grow even more rapidly due to its essential role in rural care. 

At the same time, Japan’s “Healthcare Vision 2035” plans to update the upcoming national health policy to prioritize rural health equity , digital transformation, and sustainable rural care delivery. While these efforts are certainly making important progress, the policy’s success will depend on careful implementation and ongoing support for local communities. 

Why This Matters to Me

My interest in this issue goes beyond just statistics and policy, it’s rooted in my own personal experience. My grandparents live in a rural town in Japan, and while they are fortunate to still have access to a local clinic, I have heard many stories from neighbors and family friends who have to travel hours just to get a routine clinic, I have heard stories from neighbors and friends who have to travel hours just to get a routine check-up. When I visit them, I notice how quiet the town has become, how younger people have moved away, and how the few remaining doctors are often overwhelmed. It made me realize how easily healthcare access, something that I have always taken for granted, can become fragile. This issue is not just about numbers; it’s about people who are trying to live their lives, who deserve the same level of care as anyone in central Tokyo. It has made me aware of the importance of health equity and inspired me to learn more about how technology and policy can work together to close the gaps. In the future, I hope to be part of the initiative and the solution.