At the same time as efforts for the full-fledged construction
of the comprehensive community care system
were under way, health care policy guidelines were
developed to review hospital care and home-based
medical care and to promote coordination between
medical care and long-term care.
In the late 2000s, the regional five-year health plans
drawn up by the prefectures aimed to integrate the various
providers - primary care practitioners, acute care
hospitals, rehabilitation hospitals, long-term care facilities
and home-based care [24]. The five-year plan of
fiscal year 2013 specified that achievement targets
should be incorporated in home-based medical care
and that these targets should be interlinked with the
long-term care insurance schemes [25]. Monetary
incentives were offered to realize these policy aims.
Early discharge from hospital for elderly patients and
home-based medical treatments were encouraged by
a new structure of fees under the medical insurance.
The new fees supported the coordination of care managers
in hospital discharge support and increased the
compensation to doctors who advised care managers
in home-based care.
In 2012, the budget to promote community initiatives for
home-based medical care was increased to 20 times
that of the previous year. Model projects coordinating
various means of home-based medical care have
been implemented in 105 locations nationwide. In the
model projects, coordination is based not in the community
general support centres, but at local hospitals,
clinics or other medical institutions. The bases are
staffed by specialists who are well-versed in the fields
of medical care and long-term care. The staff facilitates
smooth hospital discharge by instituting informationsharing
between primary care practitioners and hospitals,
collaborating with the community general support
centres, and keeping an eye out for new resources
that would be useful in further collaboration [26].
The Structure of long-term care envisaged under the
reform of 20011/12 is shown in Figure 3.