Transitional and Long-Term Care System in Japan and Current Challenges for Stroke Patient Rehabilitation

Abstract

In Japan, the national medical insurance system and long-term care insurance (LTCI) system cover rehabilitation therapy for patients with acute, convalescent, and chronic stroke. Medical insurance covers early and multidisciplinary rehabilitation therapy during acute phase hospitalizations. Patients requiring assistance in their activities of daily living (ADL) after hospitalization are transferred to kaifukuki (convalescent) rehabilitation wards (KRW), which the medical insurance system has also covered. In these wards, patients can receive intensive and multidisciplinary rehabilitation therapy to improve their ADL and transition to a smooth home discharge. After discharge from these hospitals, elderly patients with stroke can receive outpatient (day-care) rehabilitation and home-based rehabilitation using the LTCI system. The Japanese government has proposed building a community-based integrated care system by 2025 to provide comprehensive medical services, long-term care, preventive care, housing, and livelihood support for patients. This policy aims to promote smooth coordination between medical insurance services and LTCI providers. Accordingly, the medical insurance system allows hospitals to receive additional fees by providing patient information to rehabilitation service providers in the LTCI system. A comprehensive database on acute, convalescent, and chronic phase stroke patients and seamless cooperation between the medical care system and LTCI system is expected to be established in the future. There are only 2,613 board-certified physiatrists in Japan, and many medical schools lack a department for rehabilitation medicine; establishing such a department at each school is encouraged to teach students efficient medical care procedures, to conduct research, and to facilitate the training of personnel in comprehensive stroke rehabilitation.

Design and implementation of informatization for unified management of stroke rehabilitation in urban multi-level hospitals

“…Unlike Western countries, such as the USA and Europe, most cities in China have primary, secondary, and tertiary hospitals corresponding to the acute, convalescent, and chronic phases of stroke. Some Asian countries refer to the second level of three-level rehabilitation as transitional rehabilitation ( Leigh et al, 2022 ), which does not change the fact that they also practice three-level rehabilitation ( Kinoshita et al, 2021 ). In China, many studies have confirmed that the three-level stroke rehabilitation network is beneficial for rehabilitation of stroke patients, and was recommended by the Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders ( Zhang et al, 2020 ).…”

“…The officials advocate the establishment of a three-level stroke rehabilitation service system ( Chen et al, 2010 ), with primary rehabilitation for acute and sub-acute stroke rehabilitation in tertiary hospitals or tertiary rehabilitation hospitals, secondary rehabilitation for convalescent phase of stroke in secondary hospitals or secondary rehabilitation hospitals, and tertiary rehabilitation for chronic phase of stroke in community health service centers or township health centers or families. Although the three-level stroke rehabilitation system has established recommended referral criteria and treatment protocols ( Xu et al, 2021 ), the lack of uniform management practices across all levels of care may delay the treatment due to poor referral, indicating that coordinating the treatment of stroke patients between the acute, convalescent, and chronic phases is essential ( Kinoshita et al, 2021 ).…”

A cross-sectional survey of consistent rehabilitation through long-term care insurance in Japan: a questionnaire survey

“…During rehabilitation by LTCI, doctors’ instructions are required before starting rehabilitation through LTCI. In Japan, LTCI helps in the seamless transition between treatments from acute to chronic phases to improve and maintain functional activity of patients 6 . Disease-specific rehabilitation in each clinical department is widely recognized 7 and has been established in Japan 8 – 10 .…”

Development and usability of a hospital standardized ADL ratio (HSAR) for elderly patients with cerebral infarction: a retrospective observational study using administrative claim data from 2012 to 2019 in Japan

“…A reduction in the length of hospital stay (LOS) among patients is one aspect of this strategy. In Japan, which has a super-aged society, the shift from hospital care to community care, including shortening of the LOS, has been promoted as a health policy based on the Community-based Integrated Care System [1][2][3][4][5].…”