Our review of health-care cost-containment policies in reducing LOS identified an absence of regulations and inducements targeting particular ownership-type groups except for a series of reorganisation policies for national government hospitals and a recent reform of medical cor- porations (Fig. 3). Arguably, the former may explain why national government hospitals have their own path, for it is natural that the MHLW enforces direct control over its own hospitals. The reduction in LOS was implicitly emphasised and enforced in the reorganisation plans. The effect of the latter, a recent reform of medical corporations implemented in 2007, could not be observed within our time frame from 1971 to 2008. We found two main tendencies of the cost-containment policies: separation of acute care and chronic care and financial incentives to encourage reduced LOS (Fig. 3).
Our analyses have several shortcomings. Our analysis focuses on the category of “ordinary beds,” which include beds for chronic care, since it was the only dataset available to examine ownership differences over the last 40 years. However, this makes our interpretation ambigu- ous. A further study separating LOS for long-term care from LOS for short-term care since 2001 might reveal a different and detailed pattern according to hospital owner- ship types. Furthermore, our categorisation of hospital ownership types does not reflect hospital networks under single ownership. Private acute-care hospitals and private chronic-care hospitals may coordinate with each other. The factors not examined were demographic and epidemi- ologic transitions on the demand side, or only a brief mention of numbers of hospitals and beds on the supply side of health care, although these factors are signifi- cant determinants of LOS. And our study is embedded in the Japanese context of policies in reducing LOS, so its relevance to health system performance or hospital management was not examined. Nevertheless, the Japanese context enables us to observe LOS over the long term and its relevance to health-care policies, which makes this case study unique and worthwhile.