IX FUTURE OUTLOOK AND NEW OPPORTUNITIES
Discussed below are possible solutions currently being considered or in progress to the hot issues pointed out in Section I above.
Uneven distribution of physicians in regional areas and among departments
A bill for amendments to the Medical Care Act and the Medical Practitioners Act was submitted to the Diet in March 2018 and if enacted, will be enforced on 1 April 2019 or 2020. The main features of the bill are:
a Introduction of a new system on MHLW's accreditation of physicians with certain working experiences in regional areas facing a shortage of physicians, as managers of 'regional medical care support hospitals';
b Establishment of 'plans to procure physicians' in the 'Medical Care Plans', based on a PDCA cycle by prefectural governors, and enhancement of the cooperative functions of councils for regional medical services in prefectures;
c Reinforcement of measures for procuring physicians through training programmes, including having regional quota for admissions to medical schools in universities; and
d Promotion through conferences and setting up of policies for functional differentiation and cooperation among healthcare providers and professionals inside and outside of each medical service area.
Ageing and deterioration of medical facilities
Solutions to ageing and deteriorating medical facilities include complete reconstruction and large-scale repairs (including renovation for earthquake-resistant structures) of these facilities. We anticipate that these necessary repairs or construction will be financed primarily through debt financing by the Welfare and Medical Service Agency14 or other financial institutions and secondarily through asset financing, rather than equity funding, because of the low return on investment due to the non-profit status of medical practice.
As to asset financing such as securitisation of real estate for hospitals, on 26 June 2015 the Ministry of Land, Infrastructure and Transport issued the 'Guidelines Concerning REITs Investing In Real Estate For Hospitals', which took effect on 1 July 2015. The guidelines were issued after discussions with various interested parties including the MHLW and the Japan Medical Association (JMA)15 and placed importance on healthcare business operators and internal management systems in the licensing requirements for asset management companies of REITs. It bears mentioning that the securitisation of hospital real estate essentially requires a separation of the ownership of fundamental assets and the operation of the healthcare business, which is different from the traditional view by originators of hospital real estate that medical assets should be owned and operated by medical practitioners.
|
|
|
Despite the said guidelines, however, there has not been much progress in investments in hospital real estate so far. The first deal made by a healthcare REIT listed on the Tokyo Stock Exchange was the acquisition by Healthcare and Medical Investment Corporation of Niigata Rehabilitation Hospital by purchasing trust beneficial interest on 10 October 2017. But no other listed REITs have acquired hospital real estate since, and it seems private REITs that are preparing to acquire hospital real estate have not been listed yet. In our view, one reason is that the JMA continues to be vigilant against the entry of 'funds' that represent for-profit entities, which are inconsistent with the non-profit status of the medical practice. This approach creates anxiety among healthcare business operators about the possible discontinuation of their business because of the loss of hospital real estate in the event of non-payment of rent.
New approaches to connect the healthcare industry and the 'fund' industry are crucial. These approaches include (1) eliminating the old-fashioned view that the ownership of hospital assets and the practice of medicine should be one and the same, (2) encouraging healthcare business operators to establish and implement a more enhanced and transparent governance system, and (3) encouraging 'fund' investors not to seek excessive returns through 'ESG investing', 'SRI' or 'impact investing'.
Дата добавления: 2019-03-09; просмотров: 82; Мы поможем в написании вашей работы! |
Мы поможем в написании ваших работ!