Abstract
Due to revision of the Japanese medical fee payment system in 2002, it is estimated that most privately owned hospitals will suffer a loss of income of about 10%. In this serious situation, it is necessary to make a change in our understanding of the system and to obtain the best results with minimal cost. To deal with the serious situation, the following four items were important: emphasis on rehabilitation in the early phase, propaganda and marketing, close communication and a team approach among medical staff (i.e. physical therapist, nurse, medical social worker and so on) and the use of a critical path. And also, the following four concepts were thought to become problems in the future: the importance of informed consent by patients, carrying out evidence-based medicine, reconstruction of the payment system an assessment method for rehabilitation staff, and the introduction of a continuous internship for a career in rehabilitation staff. Indeed in this serious situation, rehabilitation staff with good skills and a warm heart will be needed in the future in Japanese society.
