In an unprecedented move, Japan is now encouraging home care for elderly patients kept alive for years by feeding tubes. The move follows the government’s plan to reduce its annual heath bill of around 38.5 trillion yen (approx. US$376 billion) by shortening patient’s stays in hospitals.
Feeding tubes at the end of life is very common in Japan, unlike its Western counterparts. Many terminally ill people and those suffering from dementia are kept alive with this practice, even without proper evaluation. As such, the Health Ministry plans to increase reimbursements to facilities that check the swallowing capability of a bedridden patient and encourage rehabilitation with eating by mouth. Dr. Kazuhiro Nagao, deputy director of the Japan Society for Dying with Dignity said, “Eating is one of the most important human dignities and the country is moving forward to protect it.” According to Gaihoren, an association of surgical societies that evaluate surgical reimbursements, around 100,700 yen ($983) is reimbursed per feeding tube surgery by the government. This covers kits and three doctors, which work for 45 minutes each. Out of the 260,000 patients that are tube-fed, more than 90 percent are in their 80s and bedridden. They are fed by tube on an average of 2.3 years. While around 25 percent of those fed on tube are able to eat by mouth again, only 2 percent go back on doing so.
Because of the decreasing labor force, fewer taxpayers are able to support the state-funded care of dependent seniors. As such, the government is decreasing reimbursements for tube feeding by 40 percent to 60,700 yen ($592) beginning in April. However, 25,000 yen ($244) will be given to the hospital if a swallowing evaluation is done to the patient before inserting the tube. Hospitals which have 50 surgeries or more will have a 20 percent decrease in payout for each tube-feeding patient “if they don’t evaluate all cases and the recovery is lower than 35 percent” by next April. Hospitals are also encouraged to speed up recovery from rehab so that patients may be discharged sooner. A new guideline to the rule to assess stroke patients’ capability to swallow will also be drawn up.
Many are doubtful that tube feeding will lessen anytime soon. Tokyo Metroploitan Institute of Gerontology researcher Tatsuro Ishizaki thinks the new rule will not have much impact. as most hospitals have less than 50 cases, which exempts them from the 20 percent cut. However, Ichiro Fujishima, director of Hamamatsu City Rehabilitation Hospital and chairman of the Society of Swallowing and Dysphagia of Japan, hopes the new rule will benefit the elderly. “A focus on swallowing evaluation and rehab will encourage doctors to think more about balancing the two and will help patients to be discharged from facilities,” he said.