2016 Volume 65 Issue 2 Pages 127-135
The establishment of the Japanese community-based care system was (first) presented in the report of the National Council on Social Security System Reform in August of 2013. Since then, each function aims at supporting the lives of the elderly people in their homes and local communities where they feel attached by dividing and/or sharing (various) care tasks. This system includes the concept of community-based care in addition to that of integrated care, which is designed to support elderly individuals with chronic health conditions and ensure their independent lives after discharge from hospitals by delivering services tailored to those individual's conditions. This integrated care is considered to contribute to the sustainability of the health system by moderating the demands of unnecessary hospitalizations and expensive emergency services and to support maintaining the quality of life of individuals to reach a high level of independence and satisfaction in their lives. In this article, I will explain the position of the Japanese community-based care system in the context of health services integration. Meanwhile, I intend to clarify the international problems with health services integration and to give insights into their solutions by reviewing previous worldwide studies. From international reviews of previous studies, integration and coordination of health services are found to be considered problematic on the international level as well. In order to facilitate integration of health services, we suggest establishment of an integrative service delivery model through systematic organization of integration frameworks (horizontal/vertical and linkage/coordination/full integration). From the domestic trends in Japan, with the prospect of further division of roles in each function in the service delivery system, it is necessary to clarify the care management process including patient admission and discharge from hospitals in order to achieve seamless care management for people with care needs. Moreover, in order to strengthen this management function, it is necessary to develop a practical tool to support better information sharing across different health care sectors. At the same time, municipal governments are expected to support this type of initiative from multiple aspects.
