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

Shoji Kinoshita; Masahiro Abo; Takatsugu Okamoto; Kohei Miyamura

doi:10.3389/fneur.2021.711470

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

Front Neurol. 2022 Jan 11:12:711470. doi: 10.3389/fneur.2021.711470. eCollection 2021.

Authors

Shoji Kinoshita¹, Masahiro Abo¹, Takatsugu Okamoto^{1

2}, Kohei Miyamura^{1

3}

Affiliations

¹ Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
² Department of Rehabilitation Medicine, Nishi-Hiroshima Rehabilitation Hospital, Hiroshima, Japan.
³ Department of Rehabilitation Medicine, Kawakita Rehabilitation Hospital, Tokyo, Japan.

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.

Keywords: acute phase; cerebrovascular disease; chronic phase; convalescent phase; long-term care insurance; rehabilitation.

Publication types

Review