[Future tuberculosis care in Japan]

In Japan, the care of patients with tuberculosis has been mainly dependent on the state of hospital wards. The number of patients that have tuberculosis has steadily declined over the years, and we are now on the way to low prevalence state of tuberculosis. However there is a need for discussion about how future care for patients with tuberculosis should take place. The problems of present tuberculosis care system are as follows: (i) there is inefficiency and difficulty in maintaining the tuberculosis wards because of the declining number of patients and specialists; (ii) there are difficulties in treating complications such as renal insufficiency which requires blood dialysis, delivery, psychiatric diseases in tuberculosis beds; (iii) there is a high proportion of elderly patients that require substantial nursing care and long-term admission in the hospital; (iv) there is not only insufficient patient care but also financial support for patients with socioeconomic problems such as foreign-born worker or homelessness, (v) in addition to the medical care for patients of MDR-TB being insufficient, there are also inappropriate environment and amenities for long-term hospitalization. Moreover the public subsidy system for medical treatment requires patients to pay 5% of expense cost in the outpatient clinic. The following points should be discussed for the future tuberculosis care system: (i) general hospitals should take more part in caring for patients with complications and there should be a close cooperation among general hospitals, tuberculosis specialists and the administration; (ii) there should be a limited number of hospitals maintained for the integrated treatment of MDR-TB including surgical treatment and suitable circumstances for long-term hospital care. Additionally, there should be a system of detention for non-adherent patients or home isolation for adherent patient; (iii) there should be reinforcement of public commitment for patients with socioeconomic problems or MDR patients such as public subsidized full coverage of medical expense, free treatment in regional health centers