【Aging, safety net and fiscal crisis in Japan】No.112: Home Healthcare

One of the pillars of health reform that the government is advancing is to realize savings in medical expenses and improve patient satisfaction by shifting the place of medical care from a hospital to a home. Therefore, the Ministry of Health, Labour and Welfare has set up a committee to build a home healthcare delivery system and is conducting comprehensive considerations.

The major services of home healthcare include visiting medical care, visiting nursing care, and managing care of death. According to a survey conducted by the Ministry in 2014, the number of clinics providing visiting medical care was 20,597 (22.4%) out of 100,461 clinics (Figure 1). Of 8,493 hospitals, 2,692 hospitals (31.7%) were providing this care (Figure 2).

Visiting nursing care is roughly divided into services to which medical insurance or long-term care insurance is applied, and services that are fully paid out of pocket. As shown in Figure 3, the number of visiting nursing stations (rather than hospitals and clinics) is increasing dramatically for organizations providing visiting nursing care. This reflects the idea that a private company is also allowed to enter the visiting nursing care market.

The most important issue in home healthcare is the expansion of the social system that manages the patient's death at home. As of 2014, the number of clinics doing so was 4,312 (Figure 4), which accounted for 4.7% of all clinics. There are only 476 hospitals (5.6%) that manage care of a patient's death at home. As mentioned in Column No. 5, the number of deaths per year is expected to sharply increase from 1,344,000 in 2017 to 1,603,000 in 2030 and 1,679,000 in 2040. If we do not expand the system for patients' death at home, many "death-place refugees" will be generated.

Figure 1: Clinics providing visiting medical care

Source: Ministry of Health, Labour and Welfare

Figure 2: Hospitals providing visiting medical care

Figure 3: Number of organizations providing visiting nursing care

Figure 4: Number of hospitals and clinics managing care of death at home