OECD Reviews of Health Care Quality: Japan 2015

Raising Standards

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This report reviews the quality of health care in Japan, and seeks to highlight best practices, and provides a series of targeted assessments and recommendations for further improvements to quality of care. One of Japan’s foremost policy challenges is to create an economically-active ageing society. Excellent health care will be central to achieving this. A striking feature of the Japanese health system is its openness and flexibility. In general, clinics and hospitals can provide whatever services they consider appropriate, clinicians can credential themselves in any speciality and patients can access any clinician without referral. These arrangements have the advantage of accessibility and responsiveness. Such light-touch governance and abundant flexibility, however, may not best meet the health care needs of a super-ageing society. Japan needs to shift to a more structured health system, separating out more clearly different health care functions (primary care, acute care and long-term care, for example) to ensure that peoples’ needs can be met by the most appropriate service, in a coordinated manner if needed. As this differentiation occurs, the infrastructure to monitor and improve the quality of care must simultaneously deepen and become embedded at every level of governance –institutionally, regionally and nationally.


Quality of mental health care in Japan

Mental health care in Japan faces a number of challenges which require urgent action. The high suicide rate, high numbers of psychiatric beds, and long average length of stay have drawn attention to Japan’s mental health system for all the wrong reasons. This picture is slowly changing. Commitment and effort over the past decade is generating positive change in the system: inpatient psychiatric beds are falling along with average length of stay in psychiatric facilities, and community care provision is increasing. These positive steps must be recognised and commended, but more remains to be done. Japan should continue to develop high quality care in the community for severe mental illness, while also turning attention to improving care available for mild-to-moderate mental illness. Despite a small number of innovative and impressive initiatives around measuring and promoting quality of care for mental health, extremely limited information availability means that a real picture of care quality is obscured. Efforts should be made to improve quality measures for all mental health care, and patient safety and care quality assurance should be priorities in inpatient care.


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