Looking ahead to the 2025 problem, the enhancement of convalescent wards in hospitals has become an urgent issue, and the national government is inducing a shift from acute wards to convalescent wards. On the other hand, it is said that the number of "rehabilitation refugees" has increased because the rehabilitation period covered by medical insurance has been restricted as part of curbing medical expenses. Therefore, what has emerged is self-financed rehabilitation, which provides full-payment rehabilitation outside the insurance. Although it costs money, it is said that there are many needs. Therefore, we report on the direction of functional differentiation of hospitals and the role of self-funded rehabilitation.
Since the baby boomer generation will be over 75 years old in 2025, it is desired to promote functional differentiation and cooperation of hospitals and beds. The "Community Medical Plan" was formulated by the national government by March 2017 in order to reduce the number of beds in the acute phase and increase the number of beds in the convalescent phase and home medical care. The hospital beds are divided into four functions, "highly acute phase", "acute phase", "recovery phase", and "chronic phase", and the required number of beds for 25 years is estimated for each of the 341 "concept areas" nationwide. .. As the population declines, the number of beds in the acute and chronic phases is expected to become excessive, and it is expected that functional conversion to the recovery phase and shift to home medical care will be promoted. Discussions on the functional conversion and reduction of beds will be held in each region toward the realization of the concept by the next 25 years.
By accumulating the number of beds for each function in the regional medical concept formulated by each prefecture, the number of beds that will be required in 2025 is 130,000 in the highly acute phase, 401,000 in the acute phase, 375,000 in the recovery phase, and chronic. The period will be 242,000 to 285,000 beds (Fig.).
On the other hand, according to the 2014 bed function report, there are 191,000 beds in the highly acute phase, 581,000 beds in the acute phase, 111,000 beds in the recovery phase, and 352,000 beds in the chronic phase. The bed function report is that all hospitals and clinics with beds that have general beds and medical care beds have "highly acute phase", "acute phase", "recovery phase", and "chronic phase" in each ward of their own hospital. It reports to prefectures what function they are performing and what they believe will be fulfilled in the future.
Although it is not possible to simply compare the future design of the regional medical plan with the bed function report, it is considered that the national government needs to switch the function from the acute phase to the convalescent phase.
Under these circumstances, some facilities have begun to switch from acute wards to convalescent wards. In the 2018 medical fee revision, the convalescent rehabilitation ward admission fee was reorganized into 6 categories, and it became possible to calculate a higher score if the requirements of the performance index were met. In order to increase the performance index, it is necessary to shorten the length of hospital stay or increase the gain on the functional independence evaluation table. In addition, at hospitals that formulate convalescent rehabilitation ward admission fees 1, rehabilitation specialists were able to perform outpatient rehabilitation for discharged patients only within 180 days after discharge (calculation was permitted beyond the upper limit of calculation days). Transitional measures will be abolished in March 2019).
There are many cases in which disability remains even after discharge from the convalescent rehabilitation ward. In addition to outpatient rehabilitation, there is also outpatient rehabilitation with long-term care insurance for those who require support or care that exceeds the upper limit of the number of days for calculating rehabilitation fees for each disease (180 days), but the main focus is group rehabilitation. The effect is limited and it is difficult to receive sufficient individual rehabilitation. There is also a view that "rehabilitation refugees" may continue to appear.
Self-financed rehabilitation is trying to meet such needs. Provide full rehabilitation at your own expense, not covered by insurance.
Wise Co., Ltd. has been working on non-insurance rehabilitation from early on. We have 12 "cerebral infarction rehabilitation centers" in 1 metropolitan area and 5 prefectures (Tokyo, Kanagawa, Saitama, Chiba, Niigata, Kumamoto). We provide unique rehabilitation for patients with cerebral infarction who are not satisfied with the rehabilitation that can be received by public medical insurance and long-term care insurance.
The goal of conventional rehabilitation is to recover activities of daily living due to limited time due to system design. On the other hand, in recent years, there has been an increasing demand for rehabilitation in anticipation of returning to work, especially among patients in the prime of work. Most of the long-term care insurance is for the elderly, and the main purpose is group rehabilitation, and the purpose is to maintain rather than improve the function, and many people are dissatisfied.
Walking training to step forward step by step while supporting
Provided by Wise Co., Ltd.
At the center, a detailed rehabilitation plan is made according to individual wishes and symptoms, and a physical therapist (PT), an occupational therapist (OT), a speech therapist (ST), etc. respond one-on-one. The procedure is acupuncture (about 45 minutes), PT / OT / ST (about 60 minutes), and training (about 15 minutes). We also offer suggestions for self-training that can be done at home and advice for families. A therapist with abundant experience in convalescent / acute rehabilitation hospitals is in charge. In the basic plan, you will receive 60 days, twice a week, for 2 hours each time. The cost is 275,000 yen (excluding tax).
The number of users exceeds 3,000. The breakdown is that within one year after the onset of stroke, more than 50%, and by age group, 65% are in their 40s and 60s. In addition to office workers, there are many professionals such as barbers, sushi chefs, musicians and doctors, and the goal is to operate computers and recover the functions peculiar to craftsmen. The sequelae of stroke are said to take longer to rehabilitate paralysis of the hands than to the feet.
The effects of rehabilitation at the facility were reported at the 2018 Japan Stroke Society. According to the report, after intensive rehabilitation for 60 days for 33 users who suffered sequelae due to cerebrovascular disease and had a period of less than 1 year to 10 years or more, the body was evaluated objectively. It is said that 81% of the respondents have improved their physical function and 77% have realized the subjective improvement. Approximately two-thirds of people have an onset of 1 year or more, indicating that it may improve even 6 months or more after the onset.
Yasuhiro Hayami, the chairman of the company, who had undergone surgery for hernia and experienced the joy of recovery from rehabilitation, said, "There are many users who can achieve good results by focusing on rehabilitation even after discharge. I want to support returning to work. "
Recently, the number of cases where doctors from convalescent hospitals come to visit the facilities and introduce patients is increasing, and the understanding from medical professionals is increasing. We are also working on rehabilitation for fibromyalgia in collaboration with a university hospital.
In February of this year, Toyota Tsusho's subsidiary Toyota Tsusho All Life also opened a rehabilitation facility in Tokyo at its own expense. A "custom-made" service is being launched in which physiotherapists and others individually create rehabilitation plans according to the user's symptoms.
The number of strokes will increase to 3 million in 2025, and the number of patients requiring rehabilitation is estimated to reach 1.5 million, and the demand for rehabilitation is expected to increase further.
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