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Japan must gear up for ‘super-ageing’ population

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Japan needs to cut the time patients spend in hospital and do better at recognising and rewarding quality care as the ranks of its elderly rapidly swell, an assessment of the Asian country’s health system has found.

The Organisation for Economic Co-operation and Development said Japan scored highly on many key indicators of health, including longevity, and stroke and cancer survival rates despite only average health spending.

The OECD’s Health Care Quality Review of Japan noted that Japan’s average life expectancy of 83.2 years was among the highest in the world, as are its five-year survival rates for breast, cervical and colorectal cancer, while its 3 per cent case-fatality rate for stroke is the lowest in the world.

The organisation said this achievement was particularly impressive given that the country spent just $US3484 per capita on health a year – very close to the average among OECD member countries.

“These outcomes are achieved by a health system that is characterised by its flexibility and light-touch governance…[which] makes the system accessible and responsive,” the OECD said.

But it warned that changes were needed if the health system was to cope with the increasing array and complexity of demands from the nation’s “super-ageing” population.

The OECD said one area where great efficiencies could be realised was in hospital care.

It said the average length of hospital stays in Japan was very long – patients stay, on average, 17.9 days in acute care, compared with the OECD average of 6.6 days.

The organisation said there was potential to provide more care outside of hospitals, cutting costs and treating patients closer to their homes and families.

The OECD said the Japanese health system also lacked sophisticated and systematic quality assurance arrangements.

It said initiatives to assess and reward quality care were often voluntary and public, were applied haphazardly, and did not reward quality in either a sophisticated or consistent way.

The OECD also urged Japan to upgrade its mental health care, noting the country’s high suicide rate. There are 20.9 suicide deaths per 100,000 people in Japan, compared with the developed country average of 12.3.

“Japan needs to shift to a more structured health system and strengthen quality governance,” the organisation said. “Delivery of the key services of primary care, acute care and long-term care should be better separated to make sure that care takes place in the right setting.

“[Also], the infrastructure to monitor and improve the quality of care must deepen and become embedded at every level of governance.”

The OECD recommended that Japan cut the number of hospital beds (there are currently 13.3 for every 1000 people, compared with the OECDE average of 4.8), while expanding nursing home places and providing a wider array of services in the community.

Adrian Rollins