Pay less, stay healthy---Japan's quest for reduction of LTC hospital beds

Japan is notorious for its unusually long hospitals stays, chiefly due to its excessive psychiatric and LTC (geriatric) hospital beds. According to OECD Health Data, Japan has 15.1 LTC hospital beds and 11.1 nursing home beds per 1000 elderly population in 2003. The number of Japan's LTC hospital beds is disproportionately larger than that of nursing homes when compared with US (4.6 vs. 44.0) and UK (2.7 vs. 19.6). The problem is that the severity of inpatients of geriatric hospitals is not significantly different from those in nursing homes. Nonetheless, LTC hospitals cost more than skilled nursing facilities and nursing homes ($3683 vs. $2775, $2658 monthly) To control the escalating cost of the LTC Insurance enacted in 2000, the government is promoting two measures: prevention of disability (presented at last year's APHA meeting) and reduction of costly LTC hospital beds by converting them into nursing homes. The government hopes to reduce LTC hospitals beds from the current 380,000 to 150,000 by 2012. To encourage community care, subsidies for housing reform are also being considered. Conversion of LTC hospital beds into nursing homes will pose a difficult challenge for hospital owners. Since staffing requirement is different for different types of facilities, restructuring of medical and nursing staff of LTC hospitals will be a problem. The most difficult of them: persuading doctors serving as hospital presidents to “demote” to nursing home directors.