How were Hospitals Affected by the Ministry’s Release of Hospital Names to be Potentially Reorganized?

Background The Japanese Ministry of Health, Labour and Welfare (MHLW) released a list of public and municipal hospitals (hereinafter “the list”) that are subject to reevaluation for hospital function. First, this study describes the functional differentiation status of Japanese hospital beds. Second, it evaluates the impact of the list release on the number of admissions in the listed hospitals. Methods Firstly, the number of hospitals and beds by the function of listed and non-listed hospitals in 2019 and 2021 were described using the bed function report. The Controlled Interrupted Time Series (CITS) analyses were subsequently conducted using Diagnosis Procedure Combination (DPC) data. Hospitals were divided near the cutoff point of the list. The outcomes were the number of admissions for gastrointestinal cancer surgery, those admitted via ambulance, or with a femoral fracture per 1,000 admissions. The exposure point was the week when the list was released. Results A decrease in the total number of beds was observed in 18.9% of the listed hospitals and 10.2% of others. Changes in bed functions were observed in 19.9% of the listed hospitals and 12.5% of others. CITS analyses showed that the rate ratio of admissions for gastrointestinal cancer surgery, those admitted via ambulance, and those with a femoral fracture in the listed hospital group after the list’s release were 1.001 (95% CI: 0.998–1.004, p = 0.619), 1.001 (95% CI: 0.998–1.004, p = 0.548), and 0.998 (95% CI: 0.998–1.002, p = 0.313), respectively. Conclusion More prominent trends of functional differentiation of hospital beds were observed in the listed hospitals. The release of the list did not impact the number of hospital admissions for gastrointestinal cancer surgery, those admitted via ambulance, or those with a femoral fracture per 1,000 admissions in the listed hospitals. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was supported by Health and Labor Sciences Research Grants from the MHLW, Japan (Grant numbers: 21IA1005 and 23H00448) to Y.I. The funders played no role in the study design, data collection and analysis, publication decision, or manuscript preparation. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Data used in this study were anonymized and approved by the Ethics Committee, Graduate School of Medicine, Kyoto University (Approval No.: R0135). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes According to the Ethical Guidelines for Medical and Health Research Involving Human Subjects of the MHLW, Japan (available from 080278.pdf), providing information to study subjects is one of the necessary conditions for waiving informed consent. The information includes the range of data users. Therefore, the datasets generated and/or analyzed during this study are available from the corresponding author and the other contact points on reasonable request. The other contact points are the Office of Research Promotion, General Affairs and Planning Division, Kyoto University (E-mail: kikaku06{at}mail2.adm.kyoto-u.ac.jp; Tel: +81-75-753-9301) and the Ethics Committee, Graduate School of Medicine, Kyoto University (e-mail: ethcom{at}kuhp.kyoto-u.ac.jp).