Reevaluating Hospital Bed Density in Japan: Toward Sustainable and Regionally Responsive Healthcare Reform

Japan’s healthcare system, while renowned for universal coverage and longevity, faces mounting challenges due to rapid aging and regional disparities. This review examines Japan’s exceptionally high hospital bed density—particularly in rural areas—despite a relatively low physician-to-population ratio. Using national statistics and international comparisons, we highlight inefficiencies in healthcare delivery and resource allocation. Regional analyses reveal that higher bed density correlates with increased medical expenditures but not necessarily with better health outcomes. A case study of Yubari City demonstrates that even after hospital closure, mortality rates remained stable and expenditures declined, suggesting that community-based care and generalist physicians can sustain population health. Structural incentives under fee-for-service payment models and decentralized hospital ownership further complicate reform. We argue for evidence-based regional planning, payment system restructuring, and a stronger role for hospital generalists in optimizing care. These reforms are essential to building a more sustainable, equitable healthcare system amid demographic decline.