HOME VISITING
MEDICAL CARE
JAPAN
IN
Japan home visiting medical
care alliance
Chairperson Nitta Kunio
Population Pyramid in 2010 (Japan)
male
total population=128, 060, 000 people
female
Elderly
(75<)
Elderly
(65~74)
working
population
(15～64）
average age
Children
（0～14）
Population
Population Pyramid in 2030 (Japan)
male
total population=116,620,000 people
female
Elderly
(75<)
Elderly
(65~74)
working
population
(15～64）
Children
（0～14）
Population
Change of number of death in age groups
before world war Ⅱ
after world war Ⅱ
future estimation
2039
(1,650,000 people)
Number
(million)
number of death
(85 years old or older)
number of death
(From 15 years old, 64 years old)
number of death
(From 65 years old, 84 years old)
number of death
number of death
(Less than 15 years old)
(From 65 years old, 74 years old)
Change of number of the patients with Home-visiting-medical care
Number of the Patients with Home-visiting-medical care is increasing, Home visit on call remains at the same level
Home-visiting-medical care is provided mainly for the age of over 75.But sometimes children and adults are receiving it, and the number is increasing.
(A)Home visiting medical care⇒visiting patient’s home at regular intervals to practice medical care
(B)Home visit on call ⇒visiting patient’s home to practice medical care by request of the patient
Change of the cost of Home visiting medical care(A) & Home visit on call(B)
Number of the patients with Home visiting medical care(A) in age groups
(The number of receipt/Month)
(The number of receipt/Month,%)
A)Home visiting medical care
(B)Home visit on call
0-4 old
5-19 old
20-39 old
40-64 old
65-74 old
75-84 old
85 years
old or older
Total
Total
Japan
United States
of America
German
France
A population of 1,000
the United
Kingdom of Great
Britain and
Northern Ireland
Japan
German
France
the United
Kingdom of Great
Britain and
Northern Ireland
United States
of America
Japan
United States
of America
German
France
the United
Kingdom of Great
Britain and
Northern Ireland
Change of the ratio between Death
at Hospital & Death at Home
at home
at hospital
(clinic)
Process of Home visiting medical care and it’s future
1990～
emergency home visit for the seriously ill case
2000
2006 establishment of home-care support clinic
2000～ clarification of the medical institutes for the patients with chronic illness
2006 establishment of public-care insurance system
of public medical plan
2012 reexamination
clarification of Home visiting medical care as a important role of solidarity of community based medical care
2014 Systematization of Home visiting medical care by legislation
COMMUNITY-BASED MEDICAL CARE
Home care
outpatient
Hospital
・lack of the hospital for acute illness
・after discharge from the hospital
・difficult to go to the hospital or clinic
☛Focus on advantage & merit of Home care!
Flow Chart of Frailty
Comorbidity
能力
frailty
Disability
death
死亡
Aging
community of
100000 people
establishment of
comprehensive
Community
care system
community of
100000 people
Hospitals for acute disease
social factors; poverty,
nuclear family, lack of family
care-givers, lack of doctors
visiting patient’s home
bone fracture, cerebrovascular
disease, myocardial infarction,
cancer, pneumonia
Hospitals for chronic disease
Nursing home
medical care at the place of daily life
→predict the process of the disease, and practice
advance care planning
difficulty of eating and swallowing
less physical abilities, Rehabilitation
sarcopenia, locomotive syndrome
incontinence, dementia, vascular
disease, cancer
medical(clinical)
ethics, one’s view of
life & death, ultimate
meaning of “Aging”
from Medical model to Daily Life model; meaningful End-of-Life (Care)
Development of comprehensive community care system
nursing-care,
rehabilitation
medical
practice
and
nursing
protection,
prevention
daily life support, welfare service
housing, daily living
choice by patient and family, and their attitude
medical
practice
and
nursing
nursing-care,
rehabilitation
protection,
welfare
frailty prevention, daily life support
housing, daily living
choice by patient, and attitude of
patient and family
Merci !
Je vous remercie de votre attention