Vietnam health care system comprises by four administrative levels of health establishments: central level, provincial level, district level and commune level. At the present, public health care sector widely coverage from central to grassroots levels. Vietnamese government targets to make health care system universal and affordable for all people. The Vietnamese health financing system has been remarkably improved along with multiple reforms, i.e., funding for health care for the poor and children under 6 yr; however, public expenditure is still low and total budget for health has not yet met the actual needs. In addition, user-fee for service was introduced in order to improve finance for health care system, which has caused increase in out-of-pocket payment.

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In the “Group homes”, one care giver is assigned to three patients placed therein, there are concerns about physical and mental health, such as stress or burnout of care givers due to overwork. This study is intended to elucidate actual conditions of mental health and burnout among care givers of dementia patients. Subjects were 107 care givers working in 12 group homes in the northern Kyushu. Additionally, WHO Subjective Well-Being Inventory (SUBI) and Maslach Burnout Inventory (MBI) were also included in the questionnaires. In the survey by SUBI, for “SUBI: Mental health degree (MHD)”, 15.9% of the subjects were in the high score group, 64.5% were in the middle score group, and 19.6% were in the low score group. For SUBI: “Mental fatigue degree (MFD)”, 49.5% of the subjects were in the high score group, 33.6% were in the middle score group and 16.8% were in the low score group. MBI three subscale scores were significantly correlated with MHD, “expectation-achievement congruence”, “family group support”, “social support”, and “general well-being and negative affect”. It is important to receive support from family members and society to maintain emotional health and prevent burnout among care givers of dementia patients. Moreover, improvement of working conditions among care givers should be considered.

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In Japan, it is estimated that one third of hospitalized aged patient stay in the hospital because of social reasons not by medical needs. This type of hospitalization has long been criticized as the hospitalization by social reason, and been required to be solved for the appropriate use of medical resources. In order to solve this problem, we have conducted a patient survey in September 2006. We have developed a questionnaire and distributed it to all long term care hospitals in Fukuoka in September 2006. The number of investigated facilities is 220. All aged patients who had stayed in the institution more than 180 d were investigated. The total number of investigated frail aged is 9,115. Among them the aged patients who were evaluated as “possible to discharge” were included into the analyses in order to investigate factors associated with their long LOS (Length of Stay). The number of cases for analyses was 4,862. The content of questionnaire is as follows: 1) Basic demographical data: age category, sex, family status (live alone or not), place of institution, 2) Health and ADL (Activities of Daily Living) status: Level of medical care needs, Level of ADL care needs, existence of dementia, medical diagnosis, 3) Social factors: willing to discharge, existence of fulfillment in life, comfort at home, economic status, social support from community. According to the results of logistic regression analysis, female, lack of assistance from social network, lack of comfort and safety at home, lack of meanings in life at home, address in Fukuoka region were associated with reluctance of discharge with statistical significance. Persons with dementia, lower ADL level, higher medical care needs showed a statistically significant positive wish for discharge. The present research has clarified that the aged with longer LOS are not necessarily persons with lower ADL level or severer dementia. They prefer to stay in hospital because they can expect a safe and comfortable daily life there. Therefore, in order to solve the problem of hospitalization by social reason, we have to organize a quality home care services as well as safety and reliable community environment.

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To examine the feasibility of detecting adverse events (AEs). A two-stage retrospective review of medical records. Seven hundred cases discharged during fiscal year 2002 were randomly selected from among inpatients, excluding psychiatric ward patients, hospitalized at seven acute-care hospitals. In the first stage of the review, trained nurse reviewers examined the medical records using 18 screening criteria to identify potential AEs. A nurse supervisor then reviewed all the cases judged as being criteria-negative by the first set of nurse reviewers and corrected the judgements as necessary. During the second stage of the review, a physician review team confirmed the occurrence, and categorized the AEs. Of the 700 cases, 79 (11.3%) cases were judged to have had AEs. Of the 79 cases, the AEs were the reason for the index admission in 26 cases, and the AEs occurred during the index admission in 53 cases. It was also judged that the AEs were highly preventable in 21 cases. Our judgement was consistent with that in the Australian survey. We confirmed the feasibility of the two-stage review process to detect AEs. To improve patient safety in Japanese hospitals, a nationwide survey, using this methodology, is necessary to fully understand the epidemiology of AEs, including the types of AEs and the contributory factors.

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