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The demand for institutional care in hospitals is greatly increasing. In 1984/85 in S. City, Osaka, the number of bed-days in hospitals of inpatients covered by the National Health Insurance Scheme, their number and the number of their insurance receipts were 32.6%, 28.3%, and 31.4% higher, respectively, than in 1981/82. The demand from inpatients aged 70-or-more was the largest factor in these increases. Of the total increase in bed-days, 68.0% was accounted for by this group. Bed-days of inpatients aged 70-and-over per 100 insured persons increased 32.6% between 1981/82 and 1984/85, and those of inpatients aged under 70 increased 10.4%. The main factor in the increase in bed-days was a significant increase in the average bed-days per year of inpatients aged 70-and-over. There was also a significant increase in the rate of admission of inpatients aged under 70.When patients aged 70-and-over were divided into those who stayed for 180 days or more in the year and those who stayed for less than 180 days, the first group contributed 92.8% of the increase in bed-days per 100 insured persons. The number of inpatients aged 70-and-over who stayed for 180 days or more accounted for 2.6% of the total number of inpatients in 1981/82. This figure rose to 4.0% in 1984/85. The percentages were not large, but the difference between rates of admission was significant. The main factor in the increase in bed-days of inpatients aged 70-and-over who stayed for 180 days or more was this increase in the rate of admission.Patients with diseases of the circulatory system had the largest number of bed-days. Of the total increase in bed-days of inpatients aged 70-and-over who stayed 180 days or more, 89.4% was occupied by an increase in bed-days of inpatients with these diseases.The most striking characteristic of the demand for hospital care in Japan is the increase in the number of elderly inpatients who stay for long periods. This increase has greatly contributed to an increase in the total bed-days for insured persons. We also found a positive relationship between the length of hospitalization and the number of beds in the hospital.

Changes in length of stay of inpatients with National Health Insurance in S.city, Osaka.