It is very common that a frail aged has multiple social and medical needs. A fragmented service delivery system is not adequate to respond to the needs of such a frail aged. It requires an integrated care service. In order to realize an integrated health services for the aged, the Japanese government has implemented the care management system into the Long Term Care Insurance Scheme in 2000. Traditionally physicians have played a key role in the authority and have influenced the care process of the frail elderly. However, the introduction of care management system under LTCI has changed the balance of authority from the physician to the care manager. Although this authority shift has not been fully accepted, this change will be an important step for the realization of integrated care delivery scheme in Japan.

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In order to clarify the factors associated with changes in dependency level of frail elderly who use the Japanese Long Term Care Insurance services, the authors have investigated the 1,736 care plans that were randomly sampled from the 2002 and 2003 LTCI data base of Fukuoka prefecture. According to the results of multiple regression analysis, the prevalence of dementia was associated with decline of dependency level (p<0.001). The care plan that well reflected client’s expectation showed a preventive effect of dependency decline with a statistical significance (p<0.001). Although there were not statistical significances, an appropriate long term goal setting and facilitation of client’s self independency also showed preventive effects (p=0.060 and 0.108, respectively). The results of current study indicated that quality of care management is important to prevent the decline of independency level among the frail elderly.

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From the government to the boardroom to the business press, everyone is talking about health care related business as one of the potentially growing industries in Japan. However, the management of new business development in health care fields is not so simple and certainly much more complicated that of the traditional industries, and demands that we fully utilize our creativity. In this article, the author demonstrates how large industrial organization embedded the health care business, which was far different from the existing businesses, in a broad-based and highly systemic way by presenting the strategic concept which conceptually made up of three nested layers—market space, business space and organizational space—. To challenge these business developments, the author presents five key agenda, and also describes the basic thoughts and methods, which are common across almost all the new business development, based on more than twenty years frontline experience in operating and managing health care businesses.

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In order to realize the informatizaton of health system, it is indispensible to standardize the data format. That is, a set of standard code of diagnoses and procedures is necessary. In Japan, there are little problems for coding of procedures, because the coding system of procedures has been already introduced into the claim processing computer system. On the contrary, the coding of diagnosis has problems for its correctness. The two mains reasons are immature ability of clinical coders and intrinsic ambiguity of ICD structure. In order to solve these problems, we have investigated the coding quality based on the Japanese casemix data, so called DPC data. Using the research results, we have categorized the pattern of mistakes and developed a set of additional code for accurate ICD indexing.

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