Medical and long-term care services provided to hospitalized patients in Japan
Two major concerns with the healthcare insurance system in Japan are the increase in medical expenses and the length of stay of hospitalized patients, which is remarkably long compared to other countries. To remedy this situation, Japan has been implementing drastic reforms to the healthcare insurance system for the last 20 years. \\n\\nOne of these reforms, launched in 2008, led to the compulsory daily evaluation of all patients hospitalized in a setting providing acute care services. This evaluation was made using a rating scale called the scale of nursing intensity and severity level of patients in general wards (or "scale of nursing intensity" for short). The scores obtained from this compulsory evaluation revealed the types of medical, nursing, and social care services provided to hospitalized patients and can be used to estimate the time spent on providing these services.\\n\\nUsing the scale of nursing intensity results as a basis, the Japanese Ministry of Health, Labour, and Welfare, which is in charge of managing the national health care system, intends to regulate the provision system of medical care services and to implement another drastic reform of the current healthcare insurance system.\\n\\nIn this research, we referenced the exhaustive national survey conducted in 2012 by the Ministry to identify the medical and nursing care services provided to hospitalized patients and how these services evolved during the hospitalization.\\n\\nResults show that almost 70% of hospitalized patients did not receive any medical care on the first day of hospitalization. Moreover, between the first hospitalization day and the sixth, this percentage was only a little above 50%. Regarding nursing care, around 60% of patients received services on the first day. However, on the second day and the days after, about 40% of patients did not receive any of these services.\\n\\nThese results suggest that many patients who should be discharged still remain in hospital. More specifically, many patients (especially elderly women) seem to stay hospitalized even after their medical treatment has finished, when they no longer require any nursing care or social care or face any particular risk of having their condition rapidly deteriorate. In other words, these patients seem to consider the hospital as less a place to treat diseases and more a kind of safe hotel. \\nThe decision to keep a patient hospitalized usually depends on the patient's intent and the doctor's consent. However, it seems that, in Japan, doctors tend to presuppose the patient's intent and make the decision for them.\\n\\nThe Japanese government is currently encouraging the specialization of hospitals in terms of functionality and hopes to implement an improved hospital discharge system. Results from the present study suggest that, in order to succeed, the government should organize a promotional campaign to increase the understanding of the population regarding the role of hospitals and the use of medical services. Another pressing challenge is to further develop the system of home care (both medical and nursing) as well as community-based integrated care, which also includes a system of temporary stays in long-term care insurance facilities.\\n\\nOur analysis of the data from the scale of nursing intensity conducted in this research should prove helpful in implementing such a system. To achieve its goal of creating an evidence-based social insurance system, the Japanese government should collect more data on the national level and examine political measures to efficiently utilize this information.
- 経営と情報 : 静岡県立大学・経営情報学部/学報
経営と情報 : 静岡県立大学・経営情報学部/学報 27 (2), 51-61, 2015-03-01