Current Conditions and Issues for Home Care Support Clinics.

Spreading and promoting home care supporting patients through the end of their lives is an extremely urgent issue in Japan’s super-aging society, where one in every three people is expected to be elderly in the near future. By 1992, the concept of visiting care, not just the traditional home visits, had emerged, with the patient’s home as the medical care delivery point. Visiting care consists of regular visits based on a medical treatment plan tailored to the patient’s illness, contrary to home visit at the patient and family request. It can be seen as a kind of ward round. A visiting nurse system for the elderly was established in 1992 under the Law on Health and Medical Services for the Elderly, and Visiting Nurse Stations began to be set up, so that this year became known as the birth of home care. Two years later, in 1994, the revised medical fee system made 24-hour emergency home visits eligible for insurance coverage, and medical fees for home care, such as visiting care, were assessed as being more advantageous. However, home care was not actively promoted. In 2000, a nursing care insurance system that aims to have society fill the gaps in home nursing, which had previously depended on families, went into effect. This upheld the integrated delivery of medical care and nursing services as the basic concept behind the program, and further raised the importance of home care. However, home care did not earn civic rights as the national government expected. Accordingly, in 2006 home care support clinics came under the rubric of medical fees, with home care increasingly seen as beneficial. As a result, home care was no longer a burden for clinic management, and we even saw the emergence of home care specialist clinics without outpatient functions.