Towards community-based integrated care: trends and issues in Japan's long-term care policy

INTRODUCTION: In 2000, Japan implemented a mandatory long-term care insurance system. With the rapid growth of the system, problems became apparent. Several critical alterations were made to long-term care insurance system, particularly with respect to integrated care. METHODS: This paper elucidates the policy trends that led to the reforms of the long-term care insurance system, which included new concepts of ‘integrated care’ and ‘community-based care’, an agenda of cost containment and service streamlining, and coordination with medical care. RESULTS: Community-based integrated care, as envisaged in the long-term care policy, includes not only the integration of medical care into service provision but also the inclusion of the informal mutual aid, oversight of for-profit providers by an administration that ensures users are not exploited and coordination between systems that cover different geographical areas. CONCLUSIONS: Japan's experience in community-based care integration suggests that this project requires multi-faceted care integration in local communities. In the future, it will be necessary to conduct empirical assessments of the effectiveness of these measures.