4.4 Regional Medical Care Delivery System Maintenance

Regional governments are also launching various measures in response to the issues of the medical delivery system. Along with establishing efficient, high-quality regional healthcare delivery systems, via the creation of regionally comprehensive systems and by enforcing the Acts for Securing Comprehensive Medical and Long-Term Care in the Community (intended to promote the comprehensive maintenance of medical and long-term care systems in each region), governments are taking major actions to establish Regional Medical Care Visions within their Medical Care Plans (MCPs) and to construct regionally comprehensive care systems. The sections below highlight specific actions.^[9]

The obligation to create Medical Care Plans (MCPs) was established in the 1985 revision of the Medical Care Act, with the objective of promoting regional healthcare delivery systems by encouraging the efficient use of medical resources. Regional governments formulate MCPs based on the actual regional circumstances they face as they work to maintain their healthcare delivery systems. MCPs include measures for the management of hospital bed numbers and the maintenance of systems needed to provide high-quality healthcare.

Each MCP must address points such as the following: (1) five diseases (cancer, stroke, acute myocardial infarction, diabetes mellitus, and psychiatric disorders); (2) five project areas (emergency care, care in the case of a disaster, care in remote areas, perinatal care, and pediatric/emergency pediatric care); (3) goals to be achieved for in-home care; (4) medical collaboration systems; (5) securing of human resources in the healthcare field; (6) promotion of information provision to the public; (7) ensuring safety in the healthcare field; (8) promotion of secondary and tertiary healthcare; and (9) standardization of calculations for general hospital bed numbers.

Regional governments typically review their MCPs in accordance with revisions to the Medical Care Act. Following the sixth revision of the Medical Care Act in 2014, in order to  “formulate regionally comprehensive care systems along with efficient, high-quality healthcare delivery systems,” regional governments have been working to comprehensively ensure medical and long-term care, to establish hospital bed function reporting systems, to formulate regional care plans, and to establish Regional Medical Care Vision Councils.^[10]

Medical and long-term care expenses are predicted to increase rapidly in 2025, when the Baby Boomers reach the ages of 75 years or over. Growth in the elderly population varies by region, so in order to effectively and efficiently distribute healthcare resources commensurate with each region’s functional needs, and based on the recognition that it is crucial each region maintain a healthcare system that can provide high-quality healthcare services in line with the circumstances of patients—whether they require acute, recovery, or chronic care—it was decided that each region should establish a “Regional Medical Care Vision” within its Medical Care Plan.

The Medical Care Act, revised in accordance with the Acts for Securing Comprehensive Medical and Long-Term Care in the Community, stipulated the establishment of plans (regional MCPs) aimed at ensuring the future of medical delivery systems. Those plans must set out Regional Medical Care Visions that include the matters specified via an MHLW ordinance such as standards for promoting the functional differentiation of hospital beds and regional collaboration. Prefectural governments must establish Regional Medical Care Visions that consider the future necessity of each medical function per vision category by making use of estimates of future regional demands and reported information. Governments must incorporate this information into their MCPs. This process helps to further promote functional differentiation across medical institutions.

Regional Medical Care Visions include the 2025 healthcare demands (categorized by inpatient/outpatient, disease, etc.), the ideal healthcare delivery system that the region aims to create by 2025 (extent of necessity for medical facilities in each secondary health management area etc.), and the measures/policies necessary for realizing these systems.

The Comprehensive Strategy to Accelerate Dementia Measures (The New Orange Plan)[11]

Aging of the population has turned dementia into one of Japan’s major issues. By 2025, roughly 7 million people will be living with dementia. Currently, 1 in 5 people aged 65 or over live with dementia in Japan, but by 2025 that number will rise to 1 in 7. In such a society, it will be important to think beyond merely supporting those with dementia and also focus on how to help them live better lives. To that end, MHLW has been seeking a wide array of opinions from various stakeholders, including people living with dementia and their families. Based on those opinions and in cooperation with other related ministries and agencies, the MHLW formulated the “New Orange Plan.”

Overview of New Orange Plan Goals

• Promote understanding and raise awareness about dementia (E.g. run awareness-raising campaigns and trainings for dementia supporters)
• Provide appropriate medical and long-term care according to the stage of the disease
  (E.g. provide thorough, patient-centered medical and long-term care, encourage people to take measures to prevent the onset of dementia, and develop systems for early diagnosis and treatment)
• Strengthen early-onset dementia policies (E.g. raise and spread awareness)
• Support caregivers for people living with dementia (E.g. create early-stage dementia Integrated Support Teams (IST) involved in early diagnosis and treatment)
• Promote the creation of aging- and dementia-friendly communities (E.g. enact abstract initiatives such as for livelihood support as well as concrete initiatives such as for the creation of easily livable environments)
• Promote R&D and the dissemination of results on topics such as dementia prevention methods, diagnostic methods, treatment methods, rehabilitation techniques, and long-term care models (E.g. clarify the pathophysiology of dementia)
• Emphasize viewpoints of people living with dementia and their families (E.g. grasp the needs of those in the early stages of dementia and support their quality of life)

Cancer Countermeasures[12]

In Japan, cancer has been the leading cause of death since 1981. In 2015 alone, 370,000 people died from cancer. In light of this situation and with the objective of further enhancing cancer countermeasures, the Cancer Control Act was established in June 2006, and enforced in April 2007. In June of 2007, in order to comprehensively and systematically promote cancer countermeasures, Phase One of the Basic Plan to Promote Cancer Control Programs was formulated.

The First Term of the Basic Plan (FY2007 – FY2011) laid out the establishment of “Designated Cancer Care Hospitals,” the strengthening of palliative care delivery systems, and the improvement of regional cancer registries. The Second Term of the Basic Plan (FY2012 – FY2016) tackled such issues as pediatric cancer, cancer education, and cancer patient employment. To add to that, in December of 2015, the “Plan to Accelerate Cancer Control Programs” was formulated.

Although a variety of efforts were made via such cancer countermeasures, Japan was unable to achieve its 10-year goal set in FY2007 of “decreasing the age-adjusted cancer mortality rate by 20% (for those under 75 years of age).” In light of the situation, Japan needs to strengthen preventive policies even further from here on out. It is also important to increase the rate of screenings for the early detection and treatment of cancers.

The overall goal for the Third Term of the Basic Plan to Promote Cancer Control Programs (FY2017 – FY2022) states that “The Japanese public, including cancer patients, will aim to understand and overcome cancer.” A categorized outline of the policies of this Term is shown below.

・Cancer prevention

(1) Primary prevention of cancer; (2) Cancer screenings and early detection (secondary prevention)

・Improvement of Cancer Treatments

(1) Genomic medicine; (2) Surgical therapy, radiation therapy, chemotherapy, and immunotherapy; (3) Team care; (4) Rehabilitation; (5) Psychological and emotional support;(6) Rare and treatment-resistant cancer (measures according to the characteristics of each cancer); (7) Childhood cancer, AYA (Adolescent and Young Adult) cancer, and cancer in the elderly; (8) Pathological diagnosis; (9) Cancer registration; (10) Efforts aimed at early development and approval of pharmaceuticals and medical devices

・Living with cancer

(1) Palliative care from the time of diagnosis; (2) Counseling and support, communication of information; (3) Countermeasures/support based on community cooperation; (4) Social issues including the employment of cancer patients; (5) Countermeasure that correspond to developmental life stages. Cancer research, human resource development, cancer education, and raising public awareness make up the foundation that supports these three pillars.

The following points are also listed as necessary for the comprehensive and systematic promotion of cancer countermeasures: further strengthening of collaboration and cooperation among stakeholders; formulation of plans by prefectural governments; efforts by the public, including cancer patients; cooperation with patient organizations; implementation of necessary fiscal measures and budget optimization/prioritization; progress assessments and reviews of the Basic Plan.

[9] Ministry of Health, Labour and Welfare “Promotion of Comprehensive Long-term and Medical Care Act” http://www.mhlw.go.jp/file/06-Seisakujouhou-12600000-Seisakutoukatsukan/0000038005_1_2.pdf (Accessed 2018, Feb.2)

[10]Ministry of Health, Labour and Welfare “Regional Inclusive Care System” http://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hukushi_kaigo/kaigo_koureisha/chiiki-houkatsu (Accessed 2017, Oct.20)

[11] Ministry of Health, Labour and Welfare “Comprehensive Strategy for the Promotion of Dementia Measures (New Orange Plan)” http://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000064084.html (Accessed 2018, Mar.2)

[12] Ministry of Health, Labour and Welfare “Basic Plan for Promoting Cancer Countermeasures”  http://www.mhlw.go.jp/file/04-Houdouhappyou-10901000-Kenkoukyoku-Soumuka/0000181862.pdf (Accessed 2018, Mar.2)