Differences in facilities' acceptance of patients under long-term care insurance in Japan.
OBJECTIVE
In April 2000, Japan launched a public, long-term care insurance (LTCI) plan for elderly people who need support. This study describes how medical support for the elderly is delivered at LTCI care facilities in Japan now and gaps between system goals and current activity. Recommendations are made for enhancing the implementation of LTCI.


METHODS
We mailed questionnaires to all health service facilities for the elderly (HSF) and special nursing homes for the elderly (SNH) located in the Kyushu area of Japan, asking whether they would accept patients with nine specific conditions.


RESULTS
We found that HSFs, which are required to employ a full-time doctor and are reimbursed at a higher rate, accept significantly fewer patients with four conditions that need medical support than are accepted by SNHs, which are not required to employ a full-time doctor.


CONCLUSIONS
In this study, we find discrepancies between system goals and current activities at LTCI care facilities. For the Japanese LTCI system to work well in the limitation of medical resources, we must understand how it really works and to reform the system continuously.
Horiguchi
Hiromasa
H
Kyushu University, Japan. hiromasa@hsmp.med.kyushu-u.ac.jp
Hara
Yuichi
Y
Ikeda
Hiroyuki
H
Nobutomo
Koichi
K
D000368:Aged; D006707:Homes for the Aged / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D015273:Insurance Selection Bias; D007353:Insurance, Long-Term Care / Q000331:legislation & jurisprudence*; D007564:Japan; D009313:National Health Programs / Q000331:legislation & jurisprudence*; D009735:Nursing Homes / Q000191:economics* / Q000706:statistics & numerical data; D010343:Patient Admission; D011795:Surveys and Questionnaires