Summary
Rehabilitation is an essential service of universal health coverage that is beneficial in maintaining the functional independence of older adults. Rehabilitation services for the developing aging society have been provided by medical and long-term care insurance services for more than twenty years in Japan. The Japanese government has developed national medical and long-term care service information systems. Data gathered are used in future studies and policy making. Information obtained from the database was analysed to clarify the provision of rehabilitation services, and future estimation, for older adults in various Japanese regions. This study showed gaps in the provision of rehabilitation in some regions, and the estimation of the future required services varied (increasing or decreasing) per region. The data gathered will be analysed by applying global standardized methods, following guidelines made by the World Health Organization. This would make our experience relevant to low and middle-income countries. Furthermore, we expect to provide evidence highlighting rehabilitation benefits for older people by analysing their functional conditions included in the LIFE database as outcome measures. The results could help to prioritize the allocation of rehabilitation resources, especially in countries or regions with limited resources.
Planning and Implementation
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What was the challenge you were trying to address?
We have conducted two projects to analyse relevant rehabilitation data: 1) rehabilitation service delivery according to regional characteristics, and 2) effective rehabilitation services for older adults requiring long-term care. The first project focused on providing rehabilitation services to older adults in areas with low resources. Data from the KDB, in collaboration with a certain prefecture, was analysed. We calculated the amount of rehabilitation supplies in medical regions, and estimated the future demands of rehabilitation of each region, using five-year age groups. The second project utilized the LIFE database. The LIFE database contains information on the functional conditions for older adults with disabilities. The effectiveness of rehabilitation services was started to be analysed using the data collected as outcome measures. Specifically, we organized the information obtained from the database, confirmed how the systems can submit data to the database, and checked for issues and limitations of the database for utilization to research.
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Who were you trying to impact?
Older people in general, Older people with chronic health conditions or disability
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What sectors were you targeting?
Health
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Who else was involved?
Government, Academia
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How did older people participate?
Older people were not directly involved
Lessons learned
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Please describe how collaboration worked in your initiative.
Firstly, we collaborated with Nara medical university. A faculty of public health from the university had extensive experience in analysing the NDB and KDB databases, and has contributed to managing the healthcare systems for older adults. Their techniques enabled us to extract and calculate data on rehabilitation claims, and to estimate the future demand for rehabilitation services. We hopefully would like to collaborate with the university and Nara prefecture to strengthen future delivery systems for rehabilitation services. Second, we collaborated with the Rehabilitation Programme of the Non-Communicable Disease Department of the World Health Organization. We held irregular meetings with the department to discuss our projects’ possible contribution to the WHO initiative of Rehabilitation 2030. We were able to gain insights into the global context of rehabilitation, and their valuable advice enabled us to consider the possibility of the contribution of our projects globally. We also realized that our data analysis could be a model case of utilizing databases, if we conduct analysis following standardized methods in WHO guidelines which other countries could refer to.
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What was the impact of your initiative on older people, their families, and/or their communities?
Our results could contribute to policymaking and systems creation. In Japan, local governments develop medical and long-term care plans every five and three years, according to the situation in each area. After which, systems and structures are established based on these plans. Our analysis of the database could clarify the needs of each region. This would aid in eliminating inequality in health for older people by optimally allocating resources based on the community's needs. Second, developing evidence of efficient rehabilitation through our analysis of the LIFE database could contribute to providing higher-quality services for older adults. Since there is little evidence of long-term rehabilitation, the criteria for rehabilitation services under long-term care insurance remains undetermined. Developed evidence in the field would allow the system to avoid under and over-treatment. The results of our study may aid in ensuring the system's sustainability in a further aging society.
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What issues did you face, and how did you address them?
Standardizing was insufficient in comparing the provision of rehabilitation services in the different regions. We will refer to existing standardization methods and apply guidelines established by the World Health Organization. Though the supply of rehabilitation services was analysed, we failed to analyse the demand for these services. The databases do not contain data relevant to the demand, so we plan to distribute an original questionnaire survey. Since we adopted population projection to estimate future demands of rehabilitation, disease incidence rates were not considered. We expect to develop an estimation with aggregation of the provision of rehabilitation by disease and adopt a model considering the disease incidence.
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What lessons did you learn from implementing this initiative?
We utilized the KDB of a single prefecture and analysed claims data of rehabilitation for older adults aged 75 years old and older by five-years age groups. The results showed that the proportion of people receiving rehabilitation (the number of patients by population) was higher for the older aged group (0.10 for the 75-79 age group and 0.26 for the over 90 age group, respectively). We calculated the average number of received rehabilitation sessions per patient. We compared it among medical areas and found that there was a maximum disparity of 1.55 times between areas. Future estimations of rehabilitation demands as the number of patients receiving rehabilitation by region were mostly increased to 2035 or 2040, while one region already reached a peak in 2019, and the future estimation was decreasing. We also compared the provision of rehabilitation services before and during the COVID-19 pandemic, through the analysis of medical and long-term care claims data. It was observed that there was an increase in rehabilitation services provided at acute and post-acute hospitals, while the provision of long-term rehabilitation in communities decreased. This may highlight the importance of quantifying the impact of crises on rehabilitation services. (Yamaguchi et al., Bull WHO, 2022)
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Do you have any other reflections you would like to share?
Lack of resources in certain regions may create gaps in the provision of rehabilitation services. Both rehabilitation services under medical insurance and long-term care insurance should be considered in creating future optimal rehabilitation. Furthermore, various services, such as functional training provided by non-rehabilitation professionals (e.g., care workers) and telerehabilitation, should be considered in addition to rehabilitation services provided by rehabilitation professionals.