@article{JHMHP10475,
author = {Shin-ichiro Miura and Yuhei Shiga and Satoshi Imaizumi and Akira Kawamura},
title = {Sustainability of university hospitals: a narrative review on governance, finance, workforce, and regional integration},
journal = {Journal of Hospital Management and Health Policy},
volume = {10},
number = {0},
year = {2026},
keywords = {},
abstract = {Background and Objective: University hospitals in Japan play important roles in the healthcare system as centers of education, research, and clinical care. However, they face increasing difficulties in providing these services in the setting of rapidly changing social and policy environments. This review aims to organize the major challenges confronting Japanese university hospitals, compare their institutional structures with those of Western academic health centers (AHCs), and explore potential directions for future reform.Methods: This review provides a qualitative synthesis of selected literature rather than a systematic review. Relevant studies and policy documents published between 2000 and 2025 were identified in PubMed, Web of Science, and Google Scholar using predefined keywords in English and Japanese.Key Content and Findings: In contrast to AHCs, which typically operate under integrated governance structures with diversified funding sources, Japanese university hospitals are characterized by fragmented governance, financial rigidity, and limited institutional autonomy. Key findings of this review indicate that governance complexity arises from the ambiguous division of authority between university headquarters and hospital management. Financial sustainability is heavily dependent on the national reimbursement system, with minimal diversification of revenue streams. Human resource challenges include physician overwork and imbalanced task allocation, which further exacerbate operational inefficiencies. In addition, the predominance of clinical duties constrains educational and research activities, while the unclear positioning of university hospitals within regional healthcare systems creates structural tension with community hospitals.Conclusions: International comparison with the United States (U.S.) AHCs and European university hospital suggests that sustainable reform of Japanese university hospitals depends on integrated governance, financial diversification, workforce redesign, and clearer regional role definition. These changes are essential for preserving their academic, clinical, and societal missions.},
issn = {2523-2533}, url = {https://jhmhp.amegroups.org/article/view/10475}
}