The Role of Private Sector Psychiatry in the Japanese Mental Health System

Abstract

Private sector hospitals are the main provider of mental health care in Japan. More than four-fifths of psychiatric beds are privately owned. Unlike Western countries, private sector hospitals in Japan serve all citizens enrolled in the universal public health insurance system. Private sector hospitals in Japan are only allowed to be nonprofit corporations. Mental health system is still inpatient oriented. Mental health professionals have recognized the importance of movements toward community mental health, but changes have been slow. The shortage of social resources in the community is one reason why many patients have experienced prolonged inpatient care unnecessarily. Although the Ministry of Health, Labor, and Welfare has declared its commitment to mental health reform, it is very difficult to establish public community mental health system from scratch because of financial problems. The Japanese mental health system received only 0.38 percent of the gross domestic product in funding. In Japan, some hold an overly optimistic view that hospitalization costs can be cut by transferring inpatients to residential community care facilities and that the savings generated can be used to pay for acute psychiatric care. However, this proposition is unfeasible because hospitalization costs have been reduced to a level equal to or below that of residential care costs in the other developed countries. Japan has established a system called hospital ward specialization. Under this system, psychiatric wards have been divided into units specializing in various areas of care. This system is not helping to decrease the number of hospital beds or the inpatient populations and has been found to be hindering deinstitutionalization in Japan. It will be necessary in the future to transition from a medical fee-for-service system that promotes long-term hospitalization and large-scale expansion to one in which downsizing correlates with better financial results.