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The pros and cons of inpatient and outpatient care

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A significant contrast between hospital care in Japan and the UK is the length of hospital stays; a large difference in the number of each country’s hospital beds may contribute to this.

According to a study by the Organisation for Economic Co-operation and Development in 2013, the UK has 2.8 hospital beds per 1,000 of the population—slightly below average for a developed country—while Japan is endowed with the highest density of the countries surveyed, at 13.3 beds per 1,000.

As a result of the way Japanese social healthcare remunerates hospital admissions, there are financial benefits for hospitals to admit patients for a longer period of time. The average hospital stay in the UK for all causes is seven days, while Japan is the outlier with the longest average hospital stay of any developed country, at 17.2 days.

In a 2009 report, global management firm McKinsey & Company said that excess bed capacity and extended hospital stays are a costly inefficiency within the Japanese healthcare system.

However, although more resource efficient, the UK model of fewer beds and shorter stays has its own set of issues. Doctors in the UK may feel under pressure to send patients home as quickly as possible. Stories abound in the British media about problems caused by unsafe or poorly coordinated discharges.

Likewise, long waits in emergency units or patients spending time on trolleys in hospital corridors are a direct consequence of fewer available hospital beds.

Foreign patients in Japan typically have mixed reactions to this difference in hospital culture. Women staying in hospital after childbirth often comment that a longer stay helped them to recover better after the delivery. Other patients complain that they have to stay one or several nights in hospital for straightforward minor surgical procedures that would be offered as a day case in another country.

For orthopaedic emergencies (typically broken bones), though, there are particular problems. Although admission to a hospital bed after such an injury is generally straightforward, if an operating theatre is unavailable some patients may wait on a hospital ward for a week or longer for an urgent procedure that might be performed within 24 hours in the UK.

Funabashi Orthopaedic Hospital in Chiba Prefecture has taken a different, innovative approach. Dr Hideaki Shiratsuchi, deputy hospital director, said that visiting doctors from France and Germany expressed surprise at Japan’s comparatively long hospital admissions.

In most Western countries, long stays after surgery are seen as undesirable because they increase the risk of hospital-acquired infections. In addition, encouraging patients to mobilise soon after surgery helps to preserve muscle function and reduce the risk of deep vein thrombosis.

After discussions with foreign orthopaedic surgeons, the hospital management at Funabashi instigated progressive steps to shorten admissions.

In 2004, at the start of this process, patients spent 14 days in hospital after a knee or hip replacement, which was typical or below average for Japan at the time. This period was gradually reduced to the point where, in 2014, hospital stays for the same operations had been reduced to five days, the normal duration of admission in most European hospitals.

At the same time, more minor procedures such as joint arthroscopies were offered as day cases: highly unusual for Japan.

The cumulative effect of this was that the hospital dramatically improved its productivity. Between 2006 and 2014, with no increase in the number of hospital beds, the volume of operations performed was more than doubled and the average hospital stay was reduced from 8.6 to 5.2 days.

At the same time, care was taken to ensure patient satisfaction remained high and outcomes were not affected.

Avoiding long hospital stays means that beds become available more quickly, leading to shorter waiting times and better availability for patients who need emergency treatment after trauma.

Time will tell whether this type of approach can serve as a template for other Japanese hospitals.

Japan’s long-term aim is for up to one-third of acute hospital beds to be gradually converted to long term care use between now and 2025 as the population ages. This may require hospitals to make more efficient use of a reduced number of beds for acute care.

Custom Media publishes BCCJ ACUMEN for the British Chamber of Commerce in Japan.

© Japan Today

©2021 GPlusMedia Inc.

14 Comments
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Kcjapan... that's not true. I work for the NHS and I can tell you that the number of infections caused by dirty wards are very very small. We also have an ageing population and some of the elderly require a lot of after are and sometimes can't go back home until their houses are modified, or other arrangements are made. We call that bed blocking. That reduces the numbers of beds available, which puts strain on an underfunded system.

Hospital Acquired Infections are also caused by hospital visitors who don't wash their hands, or are suffering from an illness themselves and pass it onto patients with weak immune systems.

I know it's fun to knock the NHS... easy target.

5 ( +5 / -0 )

I am American and just got out of the hospital in Kyoto after I broke my back. I waited 10 days for surgery, but the preparations during those ten days made my surgery much easier. A lot of other injuries from the accident had time to heal and I was rested and ready. I stayed a month after the surgery, during which time I was on my feet for all but 3 days, learning to shower and walk safely, climb stairs, do laundry, and other physical and occupational therapy. By the time I got home, I could do almost anything I did before except sit for long periods. That part is getting much better as I heal. I was quite pleased with my Japan hospital experience and the very kind and competent care I received. In America it would have been much faster, but I'm not sure it would have been as good.

5 ( +5 / -0 )

The backbone of any functioning society is good healthcare and good education. Spend the people's tax dollars on suping up these two services and make sure they are free of charge. Do that, and everything else will fall into place.

4 ( +4 / -0 )

That is what happens when hospitals don't maintain meticulous cleanliness, as is the habit in Japan

Really? Do you have any data on that?

3 ( +4 / -1 )

I suspect the comparison is skewed by differences in the notion of "hospital." Many hospitals (byouin) in Japan tend to be clinics with only a few beds. Hospitals in Britain tend to be very large, even gigantic. Japan has these as well but also many very small "hospitals."

My experience is that the large hospitals in Japan tend to move you out rather rapidly although perhaps not as rapidly as the US or the UK. It is the smaller ones that hold patients for an extended period.

Also, Japan does not make a sharp distinction between convalescent facilities and acute treatment facilities. This will again skew the comparison of days spent in "hospital."

3 ( +3 / -0 )

If you can afford to stay in hospital for a little bit longer I really do believe it is beneficial. I had surgery last month in Japan and I was in hospital for a week. What I liked about it was that I was able to talk to the doctor and the nurses on a regular basis about anything that was worrying me after the surgery. It was reassuring and I was able to relax without having to worry about anything else.

If I had had similar surgery in Australia I would have been discharged on the same day maybe with a stay overnight and would have been left to fend for myself at home. Based on my experience that would not have been ideal because I live by myself.

2 ( +2 / -0 )

Hospitals are bad for your health. It is not in the patient's best interests to keep them in longer than necessary. One you've been treated and sufficiently recovered then you need to go home. The last two operations I had in the UK were day cases, whereas in Japan I was told I would be an impatient for at least a week.

1 ( +2 / -1 )

"In a 2009 report, global management firm McKinsey & Company: . . . excess bed capacity and extended hospital stays are a costly inefficiency " - article

Notes: The author cites studies from 2004, 2006, 2009, 2014. A six year old global management report seems lazy.

Actually, the NHS is worthy of better studies than this. As far as 'germs' are concerned, infection in hospital is almost always in control of specially trained staff. If one facility has more instance of infection sanitary practices are the immediate concern.

Wholly aside from any fault finding, one must also consider the source: "Custom Media publishes BCCJ ACUMEN for the British Chamber of Commerce in Japan." For a doctor to present the 2009 findings as evidence of present day hospital utilization is would only be beneficial as a comparison study which is not found in this thesis.

That "Doctors in the UK may feel under pressure to send patients home as quickly as possible." may be an equally skewed conclusion. Perhaps this isn't because of limited resources and may not even be true?

1 ( +1 / -0 )

"I was quite pleased with my Japan hospital experience and the very kind and competent care I received." - comments

Patient outcome. Score 1 - Japan.

The pros and cons of inpatient and outpatient care, as titled, is provocative. Let the contrast begin.

1 ( +1 / -0 )

KCJapan's comment is emblematic of erroneous thought. Surgical site infection is not due to the use of dirty instruments in the do-called Western hospitals.

0 ( +1 / -1 )

I think overall I prefer Japan's system the one in the US. Unfortunately I've been in the hospital in both countries several times for rather serious reasons. Which in terms of the actual medical care and facilities, I'm not sure you can top the US considering the fact a relatively simple surgery and a 3 day stay will cost more than an education at Harvard. And cleanliness definitely goes to the US, as the regulations are far more strict... But since hospitals in the US are very business oriented, a lot of doctors and nurses are always pushing for a new treatment, instead of preventative care. I ended up having an emergency C-section in Japan after 10 days in labor and was in so much pain afterwards that I'm rather grateful for the week long stay afterwards. Not to mention whenever I, my husband or our daughter gets sick we can just pop into any doctors office anywhere and can be treated (though it might take a bit) for around 600 yen. I suppose I'm saying that, while the overall quality in the US is better (because dur, money), the accessibility of medical care in Japan is top shelf. IMO, anyway.

0 ( +1 / -1 )

A significant contrast between hospital care in Japan and the UK is the standard of the doctors!

-1 ( +0 / -1 )

The Japanese health system is world-class. The ONLY problem is, the system is abused by the elderly. What isn't mentioned in the article is, Japan also has the highest frequency of clinical visits per capita in the world (14 times per year). This abuse extends to ambulance call outs - my area alone had 20,000 of them! The system is simply unsustainable.

-1 ( +1 / -2 )

"Stories abound in the British media about problems caused by unsafe or poorly coordinated discharges." - article

That what happens when facilities and people are stretched too thin.

"In most Western countries, long stays after surgery are seen as undesirable because they increase the risk of hospital-acquired infections." - article

That is what happens when hospitals don't maintain meticulous cleanliness, as is the habit in Japan.

So, too dirty and too cheap vs. too clean and too effective. And there's a cost difference? Surprise, surprise, surprise.

-4 ( +1 / -5 )

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