Multi-layered health and welfare systems for provisioning rehabilitation for older people, adults, and children with disabilities in Japan

Abstract

With aging of the population and the epidemiological transition from communicable to non-communicable diseases, rehabilitation needs have been increasing globally. In Japan, the provision of rehabilitation services to children, adults, and older people with disabilities has gradually expanded as related laws, policies, and systems were established since the end of the World Wars. This paper summarizes the multi-layered system for providing rehabilitation services in Japan. The main frameworks for providing rehabilitation are the medical insurance system, the long-term care insurance system for older people, and the disability welfare system. Although users of rehabilitation services are required to pay a co-payment based on their income, these systems cover most of the costs. Under the medical insurance system, rehabilitation is provided by rehabilitation professionals. Recovery rehabilitation wards have provided intensive and specialized rehabilitation from acute to recovery phase, especially for non-communicable diseases such as cerebrovascular diseases, musculoskeletal diseases, and cardiovascular diseases. The long-term care insurance system has provided rehabilitation for older people who are certified as requiring long-term care. Welfare services include vocational rehabilitation for persons with disabilities as well as functional training. Furthermore, long-term developmental support is provided to children with disabilities living in the community. Training for rehabilitation professionals began in 1965 for physical and occupational therapists, followed by speech-language-hearing therapists in 1997. Educational programs for training professionals are primarily conducted at the undergraduate level, with the curriculum determined under the supervision of the Ministry of Health, Labor and Welfare and the Ministry of Education, Culture, Sports, Science and Technology, in consideration of the needs of the social situation. After graduating from training schools or universities, they are required to pass a national examination to obtain national licenses, which helps to ensure the quality of the workforce. Current policies are taking the direction of promoting community living and social participation for older people, and adults and children with disabilities, and rehabilitation plays an important role in this regard. Related systems have been continuously improved through revisions to respond to the changing social needs of the times, which ensures an appropriate allocation of the workforce and a maximization of the performance of their professional responsibilities.