【Background】 Healthy life expectancy (HLE) is of great interest from social and political perspectives. The present HLE, to which a number of policies refer, has a few problems in terms of validity. This study therefore aimed to estimate active life expectancy (ALE), one of the indicators representing HLE, at the level of secondary medical areas (SMAs), and then explore factors related to ALE at the regional level.

【Methods】 Age- and sex-specific ALE at the level of SMAs in 2015 were calculated using the Healthy Life Expectancy Calculation Program. Relationships between ALE and factors at regional level were analyzed through multiple linear regression using stepwise selection method.

【Results】 Estimated ALE at age 0 was 83.95 years for women and 79.20 years for men. Multiple regression analysis of the 331 SMA data showed that factors such as the tax revenue of tobacco had a negative association with ALE, whereas those such as the number of dementia supporters had a positive association.

【Discussion】 Selected variables can be rationally translated as factors related to ALE in terms of social and regional resources. Selected variables explained 22% to 51% of regional variation in ALE. Therefore, regional factors can contribute to people’s independence in performing activities of daily living. Further research is necessary considering the complicated structure of the determinants of active life expectancy.

Objective: The purpose of the present study was to systematically search for a cost-effectiveness analysis (cost-utility analysis) and a cost-benefit analysis using expenses under the medical system of Japan, and to examine its characteristics.

Methods: We performed systematic searches in five electronic databases, extracted data from the selected articles, and described the features of the articles. Articles in English or Japanese were selected if they included an incremental cost-effectiveness ratio, an incremental cost-utility ratio, a net monetary benefit, a net health benefit, or an incremental net benefit and if they used cost data under the healthcare system of Japan.

Result and Discussion: We identified 325 articles published from 1983 to 2018. Although health economic evaluation studies have been increasing in Japan in recent years, there were still many studies that did not adhere to key methodological recommendations for quality reporting as compared to the results of a systematic review conducted mainly in Europe and North America. The quality of studies on health economic evaluation in Japan should be improved further. To improve the quality of such studies, it is desirable to construct a database of health economic evaluation studies based on the Japanese healthcare system.

Rehabilitation counseling centers are local government agencies based on both the Act on Welfare of Physically Disabled Persons and the Act on Welfare of Mentally Retarded Persons. They are also defined as non-bed clinic based on the Medical Care Act. In addition to the committee of occupational health and safety management which was already established, we have established new policy of patient safety and started a reporting system of incident/accident cases from April 2017. This study was performed to summarize one-year practice of our patient safety as well as reviewing the past accidental reports in our center. For one year, eleven cases which are ten cases of incident and one case of accident were reported. 8 cases, which were most cases, were issues of informative security in contrast with the past reports in which physical issues like falls were the most. All reports were informed all staffs of identifying causes and their preventions in each case. We conclude that making the patient safety policy/reporting system based on the Medical Care Act was useful of forming a new safety culture in rehabilitation counseling centers.

In this pilot case, we conducted FMEA (Failure Mode Effect Analysis) using patient opinions and incident reports to determine the safety issues in facility management. The top three complaints were about the “toilet”, “sickroom”, and “bathroom”; we subsequently analyzed the incident reports from these facilities. Further, we conducted FMEA based on the results of the incident report analysis. We observed that patients were most likely to fall either when they got up from the toilet seat, wore clothes, or moved towards the sink in the toilet. We also established that in the sickroom, they tend to fall when standing up from a sitting position on the bed or when leaning forward to catch something without getting out of bed. In the bathroom, they fell backward from the stool in the dressing space. Based on these results, we suggest that conducting FMEA using patient opinions and incident report data available at hospitals may be useful for facility management, since it reveals hidden problems and helps to devise measures to counter them.