One aim of the medical system reform bills that the government has presented to the current Diet session is to cut the number of patients who are hospitalized for a long time for nonmedical reasons, such as family circumstances and a shortage of nursing care facilities. 

Such cases are dubbed "social hospitalization" patients, first surfacing in 1973 with the advent of free medical care for the elderly. 

The government has increased the amount individual patients pay for medical treatment, and reduced the fees medical institutions receive from the national health insurance system. But these measures stopped short of reducing the number of elderly inpatients. Accordingly, in the new bills the government has come up with a policy to cut the number of beds for patients requiring long-term convalescence, who are mostly elderly people in need of nursing care services. 

However, it is unclear whether this drastic measure will be effective. 

A senior official of the Health, Labor and Welfare Ministry said: "A survey showed that about half of all hospital patients are social hospitalization patients. This offers a definite basis for implementing drastic reform. It's imperative that we slash overall social security costs. Wasting medical treatment fees can no longer be tolerated." 

Social hospitalization is one reason why the average number of days a Japanese patient spends in hospital--36 days--is two to six times that of other advanced countries. Although this waste of medical fees has been taking place for a long time, a precise survey was not carried out until recently. 

The government has come up with ways of decreasing the cost of fees paid to medical institutions when patients are hospitalized for prolonged periods and increasing the cost of treatment for individual patients. But elderly patients, who have no other place to go to, have remained in hospitals. 

The government is able to tackle this thorny issue because of the opportunity presented by the Liberal Democratic Party's landslide victory in the 2005 general election and the waning influence of the Japan Medical Association. 

Medical fees have been increasing by 1 trillion yen per year, but with a declining birthrate and an aging population reducing costs is a high-priority issue. However, reform has long been considered impossible due to strong opposition from vested interest groups. 

Before compiling the draft bills, the ministry conducted its first survey to determine the number of beds used by long-stay patients whose costs were covered by health insurance or nursing care insurance. It found half of the patients hardly required any medical attention. Adding patients who required medical attention just once a week, the figure climbed to about 80 percent. Taking this into account, the draft bills call for a 60 percent cut in such beds. 

The ministry intends to abolish all the 130,000 beds allocated for nursing care services by the end of March 2012 and reduce the number of beds put aside for medical care services from 250,000 to 150,000 by the end of March 2013. Affected patients will be shifted to low-cost nursing homes or will receive nursing care at home. The construction of long-stay nursing homes will be actively promoted. 

The draft bills call for home care support clinics whose staff will make house calls and provide around-the-clock services for home care patients. Additional payments will be levied in the case of terminal care. 

Medical fees paid under the national health insurance system to hospitals with many patients who require little medical care will be greatly reduced from July. 

Currently, medical insurance payments total about 28 trillion yen a year but by 2025 this figure is expected to have doubled. The ministry plans to cut payments by about 4 trillion yen. This money will be used to expand home care services and allocate extra funding to general hospitals where doctors are said to be overworked.