Photo/Illutration A bed for a patient with the novel coronavirus at the Osaka City General Hospital in Osaka’s Miyakojima Ward on Jan. 24, 2020 (Tomoyuki Suzuki)

On a per-capita basis, Japan has no shortage of hospital beds.

Yet, thousands of individuals with COVID-19 are self-isolating at home or hotels with little access to treatment as hospitals remain overwhelmed with patients following a surge in new cases since late last year.

It all comes down to bean counters and the bottom line. COVID-19 patients require more intensive care than general patients, meaning it is not cost-effective to accept large numbers of people with the virus.

A private hospital in Osaka Prefecture that began treating patients with the novel coronavirus in July, but only those with mild or moderate symptoms, illustrates the extent of the problem.

Five of its 400 or so beds are set aside for such cases.

The hospital had been operating in the black, but reported about 150 million yen ($1.44 million) in losses during the April-June quarter.

This was due to a 30-percent decline in the number of outpatients when people started avoiding going to the hospital following the first wave of infections last spring.

After the first wave plateaued, patients began returning, raising the hospital's economic outlook.

Then the third wave of infections hit in autumn, filling up most of the beds set aside for COVID-19 patients.

The facility receives about 70,000 yen per patient with the novel coronavirus in health care services paid to medical institutions under the public medical insurance system.

Although the figure is higher than the 50,000 yen the hospital gets for a patient with pneumonia, it is not nearly enough, given the greater care COVID-19 patients require, according to the head of the hospital’s general affairs department.

“They need twice as much care as patients with pneumonia,” the official said.

The medical institution would need to assign more nurses to care for those with COVID-19. To do so, the hospital would be left with no choice but to limit the availability of treatment of patients with other illnesses.

Private hospitals account for most of the nation's medical institutions. They represent two-thirds of the 4,255 hospitals nationwide that are capable of treating patients in the acute stage.

Health ministry data in November showed that about 40 percent of those hospitals said they can accept COVID-19 patients. But of the privately owned hospitals, only 21 percent were able to. In contrast, 83 percent of public-supported institutions and 71 percent of those run by local governments said they can accept COVID-19 patients.

Takao Aizawa, president of the Japan Hospital Association, noted that private hospitals are reluctant to accept COVID-19 patients out of economic considerations.

“Most private hospitals are small or midsize,” he said. “If they convert one of their wards to treat COVID-19 patients, it will directly hit their bottom line. They are different from public hospitals, which can be sustained with an injection of taxpayer money even when they keep losing money.”

Another factor is a shortage of medical personnel who can be assigned to treat patients with the novel coronavirus.

Even though there are about 100,000 hospital beds in Tokyo, authorities have faced huge difficulties trying to secure beds for COVID-19 patients because of a shortfall in medical personnel.

In particular, facilities designated to handle serious coronavirus cases play a crucial role in the health care system that other hospitals cannot because they can also treat patients with other serious illnesses and perform surgery such as organ transplantation.

In light of this, assigning emergency doctors and those who can provide highly specialized care to treat patients with the coronavirus is not deemed practical, according to medical experts.

It turns out there is a dire shortage of intensive care specialists able to treat COVID-19 patients in ICUs.

According to the Japanese Society of Intensive Care Medicine (JSICM), Germany, with a population of 80 million, has about 8,000 intensive care specialists. In contrast, there are only around 2,000 in Japan, which has a population of 126 million.

“In Japan, the number of intensive care beds at each hospital is limited and intensive care specialists are scattered,” said Osamu Nishida, president of the JSICM. “These factors pose enormous difficulties in securing beds for patients with the coronavirus.”

To add to the challenge is the central government’s seeming inability to craft a response based on swiftly changing circumstances.

Health minister Norihisa Tamura, at a Jan. 28 meeting of the Upper House Budget Committee, expressed regret for the central government's lack of preparedness.

“The central government should have moved aggressively to secure more beds in anticipation of a sharp spike in new cases following the year-end break,” he said.