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Japan has the most beds per capita in the developed world. So why is its health system crashing?

Su became ill with Covid-19 in late December.

The single mother-of-two had a persistent fever and respiratory problems. She recognized that her asthma and chronic bronchitis had left her vulnerable to the disease's worst effects.

She called the public health center in Hyogo Prefecture for help when her condition deteriorated, but she said nobody replied to her calls.

Instead, she had to isolate herself in her tiny bedroom, while her twins, aged 3 and 6, spent nearly two weeks sleeping alone in the living room.

Her mother would drop food off for the boys, but she couldn't linger because the kids were exposed to the virus and couldn't get vaccinated for almost a week. Su said that she interacted with a tablet with her children—and could always hear them fighting.

The national healthcare system in Japan, which has the most hospital beds per capita in the developing world, has been lauded for its high standard of service in the past. The government has also attributed the long life expectancy rates of the country—the highest of the OECD countries—to its accessible, first-class health care system.

As Japan struggles with its worst wave since the pandemic started, the Covid-19 pandemic has strained the medical system to the brink. In the last two months, cases have more than doubled to more than 406,000 cases.

And although the current wave's peak duration has ended, with cases falling from more than 7,000 cases a day in January to less than 3,000 cases a day this month, the medical system is still under pressure.

As of February 4, more than 8,700 people in 10 prefectures who tested positive for Covid-19 were waiting in an isolation center for a hospital bed or room. More than 18,000 people across 11 prefectures were waiting the week before, according to the health ministries of the prefectures.

Healthcare on tap

Japan's universal health insurance scheme has offered coverage to all Japanese residents since the 1960s — irrespective of income or pre-existing conditions. However, experts claim that easy access to treatment has led many patients to seek more care than expected, taking the system for granted.

"We regard (healthcare) as something like tap water, but now the tens of thousands of people with Covid-19 had to stay home and they cannot have access to the health care system, they can't be hospitalized and they can't even see doctors," said Dr. Kentaro Iwata, professor, and doctor at the Kobe University Hospital. "That's a very harsh reality, which is very difficult to accept for many Japanese."

Waiting for hospital room is not uncommon for Covid-19 patients with serious symptoms in other countries, said Naoki Ikegami, professor emeritus at Keio University.

But in Japan's earlier waves of the pandemic, most people who tested positive for Covid-19 were hospitalized immediately, Ikegami said. The system has since been adjusted so that not everyone is hospitalized. But the rates of hospitalization for Covid-19 are still higher in Japan than in other countries.

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