2022 Volume 71 Issue 1 Pages 35-44
Rehabilitation needs have been globally increased and how to involve rehabilitation in the health care systems is important. There is a large number of rehabilitation professionals in Japan, and rehabilitation services is delivered for people who require rehabilitation in any clinical phase. We overviewed history of rehabilitation in Japan, especially focused on an aspect of the aging society.
The official history of rehabilitation professionals has begun with the enactment of Physical Therapists and Occupational Therapists Act in 1965. In 2000, the law for medical fees was renewed and a new ward of recovery rehabilitation was approved to open. More and more rehabilitation professionals have been required there. In the same year, the long-term care insurance system was established based on the principle of “support for independence.” Rehabilitation needs have grown under the system with further aging of the population.
Acute and recovery rehabilitation are mainly covered by medical insurance. There are payment systems of rehabilitation corresponding to certain major diseases such as cardiovascular, cerebrovascular, and musculoskeletal disease. Rehabilitation fee is applied for a fixed period differed by each disease ranging from 90 to 180 days. Provision of services is generally defined based on clinical evidence.
Long-term care insurance is covering rehabilitation for people in chronic conditions and long-term care needs. Therapist-led rehabilitation in this field is provided as three types of services: home visit, day care, and in-facility services. While Rehabilitation is mostly provided individually and directly under the medical systems, it varies under the long-term care systems. Functional training provided by non-rehabilitation professionals and collaborating with rehabilitation professionals are prescribed in addition to therapist-led rehabilitation. Although the systems have widely enabled older adults to receive the benefits of rehabilitation, there are still issues to be solved such as unclear applicable criteria and insufficient evidence of effective rehabilitation.
Rehabilitation is also delivered under the Community-based integrated care systems. Effective and efficient projects are created by municipalities following the regional characteristics under the systems, and rehabilitation professionals are involved in projects such as preventive population approach for healthy older adults. Rehabilitation professionals are starting to fulfill their responsibilities widely in the context of preventive care and support for independence in the community.
Through Japanese experiences and history to develop such rehabilitation services in the health care systems, we may learn lessons and get suggestions to apply to recent global initiatives on rehabilitation.
