Along with a drastic demographic change with rapid aging and decreasing total fertility rate, the place of death for Japanese has been changed dramatically in 30 years. This phenomenon gives big problems for the medical resource allocation in Japan. So, in this literature I described that estimated transition of the place of death and total number of death in Japan 2010-2055. The transition of place of death in Japan is based on a demographic survey by the Ministry of Health, Labour and Welfare. Also, future number of death is from a demographic estimation by the National Institute of Population and Social Security Research. When current proportion of death at hospitals (79.7%) is assumed to be maintained, maximum number of death at hospitals is expected to be 1.32 million in 2040, increasing by 460 thousand compared with that in 2006. When current proportion is assumed to be decreased to 1990's proportion (71.6%) in 2040, the number of death at hospitals in 2027 is expected to exceed 1.25 million, increasing by 300 thousand (1.4 times) compared with that in 2006, and this level is expected to continue until 2046. When current proportion is assumed to be decreased to 1980's proportion (52.1%) in 2040, the number of death at hospitals is expected not to exceed 1 million, and decrease after the peek of 980 thousand in 2022. It is estimated from this result that when the current proportion of place of death is maintained, the maximum number of death at hospitals is expected to reach 1.32 million in 2040, being 1.5 times compared with that in 2006. When the purpose is to maintain the current number of death at hospital, 4.5% annual increase in the number of death at home or 1.4% annual decrease in the number of death at hospitals should be aimed to improve the home care service.
According to the 2006 Health Care Reform Plan, the Japanese government intends to further develop the home care. The reform plan requires for each prefecture government to reduce the number of long-term care beds by transforming these facilities into a new type of "home for the aged", such as assisted livings and nursing homes in order to promote alternatives of in-patient care. Many countries are trying to develop alternatives to in-patient care because of increasing health care costs, pressure on acute hospital beds and increasing concern about quality of life. Developments in medical technology, improvement in housing and an increasing emphasis on primary care have all encouraged innovations that reduce reliance on in-patient care. One of such alternatives of in-patient care is Hospitalization at Home care (HAHC). The HAHC provides health care for the patients who would otherwise require hospital stay. In this article, the author will discuss the possibility to develop the Japanese style HAHC based on the comparative analysis of HAHC of France and UK.
We referred to epidemiological data from Japan and abroad related to the development and progression of diabetic retinopathy, diabetic nephropathy, an diabetic neuropathy, ischemic heart disease, and cerebrovascular disease to design risk simulation software that, when patient background data and test results are entered, graphs the incidence rates of complications and lifetime medical costs and enables calculation of expected life years and quality-adjusted life years (QALYs). We constructed 6 submodels related to retinopathy, nephropathy, and neuropathy transitions and to coronary heart disease, stroke, and mortality based on epidemiological studies from Japan and abroad. Based on statistical data, including "National Healthcare Expenditures" and "Patient Surveys", and receipt surveys in healthcare institutions, we estimated the annual treatment costs that arise in each stage of the complications. In addition, we used a literature reference from abroad to set utility values in each stage of the complications in order to calculate QALYs. To validate our software for the progression of retinopathy we used the clinical data provided from 2 hospitals and we assessed how closely the retinopathy and nephropathy stage distribution 10 yr later predicted by our software and the actual disease stages matched. Although small discrepancies were seen from the absolute values, the results of the estimations related to the progression of retinopathy and nephropathy showed that the trends were very similar, and the estimates generally appeared to be valid. Our software makes it possible to perceive the effect on future health status and treatment costs visually by inputting the various test values before and after the intervention, and it seemed to be highly useful for evaluating medical support, patient education, and preventive measures, and for designing health policy.
We developed an Internet-based body weight reduction program so called the HALSMA diet Internet version. The Internet server is set in the system by which participants and health professionals can share the data for body weight change. Using this system, we could partly automate monitoring process and then reduce the workload of health professionals. According to the result of 90 days long preliminary trial, the time for administration was reduced from 30 to 5 minutes. This amelioration of monitoring process made it possible to serve to more participants without any erosion of service quality. Furthermore, this system is expected to provide the body weight reduction program to the participants who live in the places far from the health center.