A Literature Review of Issues and Tasks by Period of Revision of Regulations Related to Convalescent Rehabilitation Wards in Japan: Focusing on Quality Evaluation

다국어 초록 (Multilingual Abstract)

Purpose: Japan established the convalescent rehabilitation wards, corresponding to Korea's rehabilitation medical institutions, in 2000 and developed it into the present system through continuous revisions. This study sought to analyze the issues and tasks faced by Japan segregated by the period of revision of convalescent rehabilitation ward-related medical fee regulations, through a literature review and further aimed to explore the direction of development of domestic rehabilitation medical institutions.
Methods: Ten revisions of the medical fee regulations were classified into three stages based on quality evaluation: (1) the quantitative expansion stage (2000–2006); (2) quality evaluation introduction stage (2008–2014); and (3) quality evaluation maturity stage (2016– 2020).
Results: The following issues and tasks emerged: (1) For the quantitative expansion stage; insufficient rehabilitation within the ward, insufficient after-hour rehabilitation, insufficient connection with acute-stage hospitals and maintenance facilities, and the low ratio of specialists. (2) For the quality evaluation introduction stage; disparity in the manpower between institutions, the necessity of a 365-day rehabilitation system, avoidance of critical patients, and the problem that an increase in the amount of rehabilitation did not lead to a qualitative improvement. 3) For the quality evaluation maturity stage; cream-skimming issues in selecting patients, inappropriate evaluation of rehabilitation effects, and the necessity of follow-up measures after discharge.
Conclusion: It is worth referring to the established regulations in Japan, and concurrently it is necessary to strengthen the evaluation of the structures, processes, and results when operating and evaluating rehabilitation medical institutions in Korea taking into account the side effects that could be identified in Japan.

참고문헌 (Reference)

1 진상현 ; 박진희, "한국과 독일의 원자력정책에 대한 비교연구: 정책흐름모형을 중심으로" 한국정책학회 21 (21): 265-290, 2012

2 이유리 ; 최성경 ; 김인숙 ; 강선주, "간호사와 간호조무사의 업무 및 자격관리에 대한 정책결정과정 연구: 킹던의 정책흐름모형을 중심으로" 한국보건사회연구원 38 (38): 489-519, 2018

3 Ministry of Health and Welfare, "「Community integrated care」, the first step in 8 local governments"

4 Kyoto Medical Practitioners Association, "“Rehabilitation-related organization council” established by reorganizing 5 group council"

5 Ministry of Health and Welfare, "“Providing social services centered on home and local communities” full-scale promotion of community care"

6 Mannheimer LN, "Window of opportunity for intersectoral health policy in Sweden-open, half-open or half-shut?" 22 (22): 307-315, 2007

7 Inpatient Medical Subcommittee of Ministry of Health, Labor and Welfare, "Whether the ADL evaluation in the rehabilitation ward is inappropriate, why not consider measures to promote the implementation of cardiac rehabilitation?"

8 Ishikawa M, "To further evolve the convalescent rehabilitation ward" 53 (53): 190-196, 2016

9 Donabedian A, "The quality of care : how can it be assessed?" 260 (260): 1743-1748, 1988

10 Ministry of Health, Labor and Welfare, "The long-term care act"

11 Ministry of Health, Labor and Welfare, "The act of totally reservation of medical care and nursing care"

12 Kaifukuki Rehabilitation Ward Association, "Survey report on the current status and issues of convalescent rehabilitation ward" 5-166, 2021

13 Ministry of Health, Labor and Welfare, "Social security reform program law"

14 Ito T, "Roundtable discussion : thinking about the convalescent rehabilitation ward" 12 (12): 2-10, 2005

15 Japanese Chronic Medical Association, "Request for revision of medical fees in 2010"

16 Ministry of Health, Labor and Welfare, "Overview of the revision of medical fees"

17 Central Social Insurance Medical Council, "Outcome evaluation of convalescent rehabilitation ward, should it be stricter in the next revision?"

18 Ministry Health and Welfare, "Notification on the designation and operation of rehabilitation medical institutions"

19 Ministry Health and Welfare, "Notification of evaluation plan related to 「1st Rehabilitation Medical Institution Designation」"

20 Koga N, "National questionnaire survey to understand the current situation of stroke community medicine : current status of hospitalization facilities during the maintenance period" 30 (30): 710-722, 2008

21 Kotake A, "Improve the quality of convalescent rehabilitation wards with outcome assessment" 6 (6): 105-109, 2009

22 Inpatient Medical Subcommittee of Ministry of Health, Labor and Welfare, "FIM evaluation in convalescent rehabilitation ward, implementation of central intravenous nutrition in medical treatment ward, verification of proper performanc"

23 Health Insurance Review and Assessment Service, "Evaluation of rehabilitation medical institution designation and operation pilot project and performance evaluation and compensation system development"

24 Ministry of Health and Welfare, "Enforcement rules of the act on the guarantee of health rights for disabilities and access to medical access"

25 Ministry of Health and Welfare, "Enforcement decree of the act on the guarantee of health rights for disabilities and access to medical access"

26 Oshima S, "Current status and subjects of convalescent rehabilitation ward" 39 (39): 359-361, 2002

27 Kurosawa T, "Current status and problems of convalescent rehabilitation ward" 39 (39): s124-, 2002

28 Ikenaga Y, "Current status and issues of convalescent rehabilitation wards : reexamination of indications for convalescent rehabilitation wards" 42 (42): 609-636, 2005

29 Sonoda S, "Current status and issues of convalescent rehabilitation wards : merits and demerits of convalescent rehabilitation ward" 42 (42): 609-636, 2005

30 Watanabe S, "Current status and issues of convalescent rehabilitation ward" 46 (46): 799-807, 2009

31 Rehabilitation-related Organization Council, "Convalescent rehabilitation ward 1. consider making “third-party evaluation” requirements to ensure a systematic and correct evaluation system"

32 Inpatient Medical Subcommittee of Ministry of Health, Labor and Welfare, "Considering evaluation of convalescent rehabilitation ward, “providing rehabilitation after discharge”"

33 Inoue Y, "Consideration on the actual condition of the convalescent rehabilitation ward from a national survey : a study on the ideal state of the convalescent rehabilitation ward" 68 (68): 55-61, 2003

34 Central Social Insurance Medical Council, "Consider raising the standard value of the convalescent rehabilitation ward 1, 3, 5, and the rehabilitation performance index"

35 National Convalescent Rehabilitation Ward Liaison Council, "Combined process with “quality evaluation” for the evaluation of convalescent rehabilitation ward"

36 Kingdon JW, "Agendas, alternatives, and public policies" Brown and Company 1-273, 1984

37 Kaifukuki Rehabilitation Ward Association, "About the kaifukuki rehabilitation ward association"

38 Statistics Korea, "2021 senior citizen statistics"