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Objective: In this study, we aimed at examining how disparities in selected medical care resources across secondary medical care sectors (SMCSs) changed over a twelve-year period following the introduction of the Medical Care Plan., Methods: Changes in all SMCS boundaries prior to 2002 were identified from data published by the Ministry of Health and Welfare and prefectural governments. The per capita numbers of ordinary hospital beds and X-ray computed tomography (CT) scanners in hospitals were chosen as indicators of medical care resources, representing respectively mandatory and nonmandatory components of the Medical Care Plan. Their interquartile range and quartile variation coefficient were used as measures of disparity among SMCSs., Results: The number of ordinary hospital beds per capita did not increase significantly between 1988 and 2000 in Group-A SMCSs (population density > or = 1000/km2) but increased significantly in Group-R (population density < 300/km2) and Group-U (300/km2 < or = population density < 1000/km2) SMCSs. The disparity in the per capita numbers of hospital beds among all SMCSs however decreased as a whole. The per capita numbers of X-ray CT scanners increased significantly in all three groups of SMCSs between 1987 and 1999. The coefficient of quartile variation for X-ray CT scanners remained larger than that for ordinary hospital beds over the 12-year period with the exception of Group-A SMCSs., Conclusions: The disparities in medical care resources among SMCSs decreased for ordinary hospital beds more markedly than for X-ray CT scanners, possibly as an effect of the implementation of the Medical Care Plan.

In 1951 when TB Control Law was legislated, and the government of Japan started intensive TB programme mainly consisting of mass health examination, BCG vaccination and distribution of appropriate treatment for TB cases, there were about 100,000 beds for TB, similar to the number of then TB deaths, and many TB patients died before admission to sanatoria. Urgent measures were taken to increase beds for TB with a target of 250,000, 2.5 times of then TB death. The target was achieved in 1957. Thereafter, the number of beds for TB as well as the occupancy rate had decreased with the decline of TB, and then policy on beds for TB could be summarized as follows: (1) top priority was given to increase the number of beds for TB, (2) general hospitals were improved with the progress of medical science and economic development, while no improvement was done on TB beds with the assumption that the need for TB beds will soon disappear, (3) minimum unit of TB beds was a TB ward with generally 40 to 50 beds, (4) an idea to provide TB bed in a general hospital came out only since 1992 as a small model project, (5) it was intended to segregate infectious TB patients from the community, however, no consideration was made about super-infection among patients themselves and the infection to health care workers, (6) admission of TB cases to a general bed and admission of non-TB cases to a TB ward was not legally permitted, (7) cost for TB treatment was set on a low level. Recent data indicate that the occupancy rate of TB beds was 43.5%, and the average stay in TB beds is still slightly over 100 days, and observing by prefectures, marked differences were seen. Taking into account changes in the pattern on TB patients such as aging and the increase of cases with serious complications and most health care workers in TB wards are not yet infected with TB, it is needed to divide TB beds into two types, one for new cases and the other for chronic cases. Beds for new cases should be provided in principle as a single room in a general hospital with good ventilation system, and DOT should be started in a hospital. Stay in this type of bed should not exceed 2 months, and higher medical fee should be provided. Beds for chronic cases could be provided in a TB ward. MDRTB cases are admitted in bed for chronic cases, however, preferably in a single room, and if active intervention such as chest surgery is tried in a few sophisticated hospital, medical fee for acute bed should be applied. Now, we have to change our mind from old concept of beds in TB ward to a TB bed in a single room with good ventilation.

In order to obtain information on the elderly cared for in long-term facilities, regarding their needs and the actual services received in these facilities, and to determine which facility could provide the most suitable service, elderly in two areas, urban S area and rural N area, were surveyed. The results were as follows. (1) The proportion of elderly placed in hospitals where the suitable care placements were hospitals was 84.6% in S area, and 66.6% in N area. (2) In elderly cared for in long-term facilities, the proportion of persons where the suitable care placement was in-home care was 11.7% in S area, and 14.1% in N area. (3) Therefore estimates for the elderly that would be for at home increases by 21.1% in S area and 27.2% in N area than the estimated figures used in plan for Elderly-Health Welfare in 2,000 AD.

The government "Well-Aging Community Promotion Program" (WAC) defines a "Well-Aging Facility" (WAF) consisting of a gymnasium for the elderly, an education-center for the elderly, a service-center for handicapped elderly and their families, and a fee-for-service nursing home, and incorporated funding provisions for WAF. Because of economic reasons, with the exception of fee-for-service nursing home, there is only one WAF at present. An economic-feasibility study of WAF was conducted based on regional analysis of existing public facilities and the needs of the elderly, and proposals for promoting WAF and WAC were made. The results are as follows: 1. In large and middle-size cities, many types of public facilities exist within walking distance, but the number per capita of elderly is low. In small-size cities and towns the number per capita of elderly is high, but are rarely within walking distance. 2. Rather than investment in facilities, the role of private business in WAC can be described as investment in services such as management-services for public facilities and transportation among facilities. 3. As for economic feasibility of WAF, in large and middle-size cities the education-center is viable, but for the gymnasium facility it would be based on utilization of facilities not only for elderly but multi-generational. The feasibility for the service-center will be high in large cities but low in middle-size cities. 4. For small-size cities and towns, the management of the gymnasium, and the education-center will be feasible, but the service-center will be difficult. 5. To promote WAC in small-size cities and towns, the following will be needed. a. The development of transportation systems between homes and facilities. b. The promotion of multi-purpose use of facilities beyond the established purpose of each WAC public facility. c. The establishment of new multi-sectional management entities by both the public and private sectors to manage existing public facilities. d. Development of financial support program by the government for upgrading and remodeling of existing facilities to function as an alternative of the WAF.

An interview survey was held with the purpose of grasping the problems faced by the home care elderly living in Koga city in Ibaraki prefecture. The subjects of the study were 100 cases who had been registered as elderly requiring home care in the municipality. The main results were as follows: (1) The most frequent underlying disorders that were considered as causes of disabilities in the home care elderly were cerebrovascular diseases, senile dementia and external injuries. In 67 percent of the subjects, one of these three disorders had caused the disabilities. (2) Disabilities in self care activities and in mobility were closely related to each other and the order of the difficulty in performing these activities was similar in many cases. A large number of the subjects sustaining severe disabilities expressed discontent with their daily life. (3) Forty two percent of the subjects were so-called bedridden elderly who got out of bed for less than 3 hours a day. The Barthel index score was 60 or less in all of the bedridden subjects. (4) For most of the bedridden elderly, bed rest was not required and probably exacerbated the disuse syndrome. In order to ameliorate their condition, adequate rehabilitation programs and assistance in their daily activities need to be offered. (5) Seventy eight percent of the care givers complained about the burden of care. Those who had no assistant care giver complained more frequently. Many of the care givers complaining about their burden had their own health problems. (6) The utilization of social welfare services were not always without any problems. The number of the experts who can deal with the psychosocial aspects in the elderly should be increased in order to improve the situation.