Journal of the National Institute of Public Health
Online ISSN : 2432-0722
Print ISSN : 1347-6459
ISSN-L : 1347-6459
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Multi-layered health and welfare systems for provisioning rehabilitation for older people, adults, and children with disabilities in Japan
Kaori YAMAGUCHI , Kumiko IMAHASHI, Makoto KONO, Rina ISHIWATA
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Keywords: rehabilitation, service delivery, health and welfare systems, rehabilitation workforce
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2025 Volume 74 Issue 1 Pages 2-14

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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.

Translated Abstract

今日，高齢化や非感染性疾患（NCDs）への疫学的移行に伴い，世界的にリハビリテーションニーズが高まっている．日本において，障害児・者・高齢者へのリハビリテーション提供は，戦後から関連する法律・制度が整備され徐々に拡大してきた．本稿では，本邦において，医療，介護，福祉など異なる複数のシステムを基盤に重層的に整備されているリハビリテーション提供体制について整理する． 今日の日本におけるリハビリテーション提供にかかる主たる枠組みは，医療保険制度，介護保険制度，そして障害福祉に関する制度である．リハビリテーションサービスの利用者は所得に応じた自己負担は生じるものの，費用はこれらの制度の中で支給される．医療保険制度下では，リハ専門職による医学的なリハビリテーションが提供され，回復期病棟の創設により，特に脳卒中などの脳血管疾患，骨折などの筋骨格系疾患，心疾患などのNCDsに対しては，急性期から回復期までの間，集中的で専門的なリハビリテーションが提供される．介護保険制度では，要介護状態となった高齢者に対して，リハビリテーションが提供される．障害福祉においては，機能訓練のほかに，就労関連のリハビリテーションが提供される．また，地域に暮らす障害のある児に対する発達支援も長期にわたり提供される． 国家資格としてのリハビリテーション専門職の養成は，理学療法士・作業療法士の養成が1965に始まり，言語聴覚士の養成が1997年に開始された．専門職養成のための教育プログラムは主として高校を卒業した者を対象に大学レベルの教育で行われ，そのカリキュラムは社会的なニーズを反映したものとして，厚生労働省および文部科学省の監督のもとで決められている．資格を得るためには，養成校を卒業後，国家試験に合格する必要があり，これが労働力の質の担保に繋がっている． 高齢者，障害児・者の施策は，地域生活・社会参加を促進する方向で進められえており，これにおいてリハビリテーションは重要な役割を果たす．変化し続ける社会のニーズに応じるため，労働力が適切に配置され，求められる役割を最大限果たせるよう，改定を重ねながら制度が構築されている．

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