Types of Hospitals and Wards in Japan｜How the Medical Fee System Classifies Them

"Acute care hospital," "care-mix hospital," "integrated community care ward" — Japanese healthcare news, job listings, and hospital websites use many labels for hospitals and wards. These labels do not sit in a single taxonomy; two overlapping axes are at work: classification under the Medical Care Act and classification under the medical fee (shinryo hoshu) system. This article separates the two axes and organizes hospital and ward types accordingly.

As a premise, fee points and facility standards are revised every two years. This article prioritizes understanding the structure; where specific figures appear, they are reference values as of the FY2024 revision (effective June 2024). Always verify changes in the FY2026 revision (effective June 2026) against MHLW notices and the latest fee schedule.

Two axes: the Medical Care Act and the medical fee system

The Medical Care Act governs the establishment, structure, and staffing of healthcare facilities. The hospital/clinic distinction, bed categories, and approval systems such as specified-function hospitals and regional medical support hospitals all derive from it. In short, it is the axis that decides what kind of facility an institution is recognized as.

The medical fee system, by contrast, sets official prices for medical services under the Health Insurance Act. When a hospital admits a patient, which inpatient fee and how many points per day it can bill depends on the facility standards each ward has registered. This axis decides what function a ward is evaluated as providing.

Confusion arises in practice because the two move independently. A ward that is a "general bed" under the Medical Care Act might be billed as an acute general inpatient ward, an integrated community care ward, or a recovery rehabilitation ward. Conversely, a single hospital often contains wards billing different inpatient fees, a form known as "care mix."

• Medical Care Act axis: hospital vs clinic, bed category, approved hospital type (specified-function, regional support, etc.)
• Medical fee axis: inpatient fees registered per ward (acute general, integrated community care, recovery rehab, long-term care, etc.)
• Third axis: the four functions under bed function reporting (advanced acute, acute, recovery, chronic)

Hospital types under the Medical Care Act

The Medical Care Act defines a facility with 20 or more beds as a hospital and one with 19 or fewer (including none) as a clinic. Hospitals with special approval include specified-function hospitals, regional medical support hospitals, and clinical research core hospitals; others are generally called general hospitals. Hospitals with only psychiatric beds are sometimes distinguished as psychiatric hospitals.

Specified-function hospitals are approved by the Minister of Health, Labour and Welfare to provide, develop, and train in advanced medicine; they are mainly university hospital main campuses and specialized centers such as the National Cancer Center. Requirements include 400 or more beds, 16 or more departments, and a referral rate of 50% or higher; the fee schedule also provides a dedicated specified-function hospital inpatient basic fee.

Regional medical support hospitals are approved by prefectural governors to back up primary care physicians by accepting referrals, sharing equipment, providing emergency care, and training local staff. They generally have 200 or more beds and must meet referral and counter-referral rate requirements. In the fee schedule they are recognized through the regional medical support hospital inpatient care add-on.

Clinical research core hospitals are approved to promote high-quality clinical research and trials needed to develop innovative Japanese-origin drugs and devices. Their approval rests on research infrastructure; there is no dedicated inpatient fee category, but they are a group with elevated EHR requirements in the context of data use and clinical research.

• Hospital: 20+ beds. Clinic: 19 or fewer (with or without beds)
• Specified-function hospital: MHLW-approved; advanced care, training, development (university hospitals, etc.)
• Regional medical support hospital: governor-approved; referrals, shared equipment, emergency care, training
• Clinical research core hospital: hub for high-quality clinical research and trials
• General and psychiatric hospitals: all others; the large majority of hospitals

Bed categories under the Medical Care Act

The Medical Care Act divides beds into five categories: psychiatric, infectious disease, tuberculosis, long-term care (ryoyo), and general. Long-term care beds are for patients who mainly need extended care; general beds are those not falling under the other four. Staffing standards for physicians and nurses and structural standards such as room area differ by category.

The key point is that bed categories under the Act and inpatient fees under the fee schedule are not one-to-one. General beds include not only acute general wards but also integrated community care wards, recovery rehabilitation wards, and wards billing the disability facility inpatient basic fee. Long-term care beds typically bill the long-term care ward inpatient basic fee, but an integrated community care ward can also be registered on long-term care beds.

• General beds: not in the other four categories; carry diverse inpatient fees from acute to recovery
• Long-term care beds: mainly for extended care; typically the long-term care ward inpatient basic fee
• Psychiatric beds: for patients with mental illness; matched by the psychiatric inpatient fees
• Infectious disease and tuberculosis beds: for legally designated infectious disease and TB patients

The four functions under bed function reporting

Under bed function reporting, launched in 2014, hospitals with general or long-term care beds report each ward's function to the prefecture as one of four: advanced acute, acute, recovery, or chronic. These four functions underpin regional healthcare visions and serve as a common language when discussing bed surpluses and shortages by region.

The four functions are neither Medical Care Act approvals nor fee-schedule inpatient fees; they are self-reported. In practice, however, they correspond closely to the registered inpatient fee: ICU and emergency care wards are typically reported as advanced acute, acute general wards as acute, recovery rehabilitation and integrated community care wards as recovery, and long-term care wards as chronic.

From FY2025 onward, in addition to bed function reporting, new function categories are being organized toward the next regional healthcare vision, such as coordination with outpatient, home care, and long-term care. Discussion points toward reporting the role of each institution as a whole alongside ward-level functions, making it increasingly important for hospitals to clarify which role they play.

• Advanced acute: ICU, emergency critical care, and other especially intensive functions
• Acute: care aimed at early stabilization of acute patients
• Recovery: care and rehabilitation toward home discharge for post-acute patients
• Chronic: inpatient care for patients needing long-term treatment

Ward types in the fee schedule: inpatient basic fees and specific inpatient fees

In the fee schedule, a ward's type is determined by the inpatient fee it registers. Inpatient fees fall into two groups: inpatient basic fees and specific inpatient fees. Inpatient basic fees evaluate the ward's fundamental structure such as nurse staffing and average length of stay, with categories including general, long-term care, tuberculosis, psychiatric, specified-function hospital, specialty hospital, disability facility, and clinic-with-beds.

Specific inpatient fees are comprehensive fees billed in place of the inpatient basic fee for particular functions or patient groups. Examples include intensive care unit management fees, the integrated community care ward fee, the recovery rehabilitation ward fee, the palliative care ward fee, and the psychiatric emergency acute care fee; most bundle part of the tests, medications, and procedures.

In other words, what people call an "integrated community care ward" or "recovery rehab ward" is the common name of a ward that has registered a specific inpatient fee. Likewise, "7:1 ward" and "10:1 ward" refer to the nurse staffing of the acute general inpatient basic fee, and "long-term care ward" to the long-term care ward inpatient basic fee; in each case the name of the fee has become the name of the ward.

• Inpatient basic fees: general, long-term care, TB, psychiatric, specified-function, specialty, disability facility, clinic-with-beds
• Specific inpatient fees: ICU/HCU management, integrated community care, recovery rehab, integrated community medical care, palliative care, psychiatric emergency acute, etc.
• Ward nicknames usually come from the fee name (7:1 ward, recovery rehab ward, etc.)

Acute wards: the acute general inpatient basic fee and advanced acute specific fees

In the FY2018 revision, the general ward inpatient basic fee was reorganized into the acute general inpatient basic fee and the regional general inpatient basic fee. The acute general fee has grades 1 through 6; grade 1 requires 7:1 nurse staffing and grades 2 through 6 are based on 10:1. Higher grades require a larger share of patients meeting the severity and nursing-need criteria and carry higher points.

The FY2024 revision shortened the average length-of-stay requirement for acute general grade 1 from 18 to 16 days and revised the nursing-need evaluation items and thresholds. For reference, acute general grade 1 was 1,688 points per day as of the FY2024 revision. Such tightening reflects a policy direction of asking whether acute wards are truly treating acute patients.

Within acute care, the most intensive wards bill specific inpatient fees such as emergency critical care, the intensive care unit management fee (ICU), the high care unit fee (HCU), the stroke care unit fee (SCU), and the neonatal intensive care unit fee (NICU). They require high structures such as continuous physician presence and 2:1 or 4:1 nurse staffing, and are generally reported as advanced acute in bed function reporting.

Most acute hospitals are also DPC/PDPS hospitals, paid a per-diem bundled rate by diagnosis group. In DPC hospitals the portion corresponding to the inpatient basic fee is replaced by the diagnosis-group bundled points, but the registered inpatient fee grade is reflected in the bundle via functional evaluation coefficient I, so the grade remains important.

• Acute general grade 1: 7:1, average stay ≤16 days, high nursing-need threshold (as of FY2024)
• Acute general grades 2–6: 10:1, average stay ≤21 days, graded nursing-need thresholds
• Advanced acute specific fees: emergency critical care, ICU, HCU, SCU, NICU, etc.
• Even in DPC hospitals, the fee grade affects revenue through coefficients

Regional general inpatient basic fee and the integrated community medical care ward

The regional general inpatient basic fee covers general wards operating at 13:1 or 15:1 nurse staffing. It applies to wards in small and mid-sized or community hospitals that do not run as intensive a structure as acute general but absorb a broad range of local inpatient demand. Grades 1 and 2 require an average stay of 24 days or less and grade 3 of 60 days or less, and they admit a wide range of conditions such as pneumonia, heart failure, and fractures in older adults.

The integrated community medical care ward fee, created in the FY2024 revision, positions a ward to receive older emergency patients and comprehensively provide rehabilitation, nutrition management, and discharge support. Requirements include 10:1 nurse staffing, full-time physical therapists and similar staff, prevention of ADL decline, and a home discharge rate. It is drawing attention as a new ward type filling the gap between acute general and integrated community care.

• Regional general grades 1–2: 13:1, average stay ≤24 days
• Regional general grade 3: 15:1, average stay ≤60 days
• Integrated community medical care ward: a 10:1 ward for older emergency patients, integrating rehab, nutrition, and discharge support

Recovery wards: integrated community care and recovery rehabilitation

The integrated community care ward fee was created in FY2014 for wards serving three functions: accepting post-acute patients, accepting emergency admissions from home or facilities (sub-acute), and supporting home discharge. It has grades 1 through 4 with requirements including 13:1 nurse staffing, rehabilitation professionals, a home discharge rate, and a share of admissions from home. Stays are capped at 60 days and points are flat regardless of day.

The recovery rehabilitation ward fee applies to wards providing intensive rehabilitation after events such as stroke or hip fracture with the aim of home discharge. It has grades 1 through 5, with requirements including a "performance index" measuring rehabilitation outcomes, the share of severe patients admitted, and a home discharge rate. A distinctive feature is a maximum stay defined per target condition, and the daily volume of rehabilitation delivered is high.

Both are classified as recovery in bed function reporting, but their patients and operations differ considerably. Integrated community care wards accept broadly without restricting by disease and also serve a sub-acute function. Recovery rehab wards are limited to target conditions, and outcome measures directly affect revenue. For small and mid-sized hospitals, the ratio of these two ward types is a key strategic decision.

• Integrated community care ward: post-acute, sub-acute, and home discharge support; 60-day cap
• Recovery rehab ward: limited target conditions; evaluated by performance index, severe patient share, home discharge rate
• Both are "recovery" in bed function reporting; operating models differ greatly

Chronic wards: long-term care and disability facility inpatient basic fees

The long-term care ward inpatient basic fee targets patients needing extended care and has grades 1 and 2. Nurse staffing is 20:1, and per-diem points are set by evaluating each patient's "medical category" and "ADL category." The FY2024 revision split the medical category into "disease/condition" and "procedures," refining the combinations from 9 to 27 classes (30 including SMON and similar cases).

The medical category rates the need for medical care on three levels, with category 3 the highest. Determining the category requires daily documentation not only of diagnoses but of procedures performed and patient condition, leaving an evidence trail. In long-term care wards, how to record this evidence completely and efficiently is therefore a central issue for both billing accuracy and nurse workload.

The disability facility inpatient basic fee applies to wards mainly admitting patients with severe physical disability, spinal cord injury and similar severe disabilities, severe disturbance of consciousness, muscular dystrophy, or intractable diseases, with grades from 7:1 to 15:1. Like long-term care wards, stays are mainly long-term, but the patient population is restricted and grades follow nurse staffing.

• Long-term care ward fee: 20:1; per-diem points set by medical category × ADL category
• FY2024 revision split the medical category into disease/condition and procedures, refining classes
• Disability facility fee: long-term wards for a restricted patient population; 7:1 to 15:1

Psychiatric wards

Fees for psychiatric beds start from the psychiatric ward inpatient basic fee (grades from 10:1 to 20:1) with multiple specific inpatient fees layered by function: the psychiatric emergency acute care fee and psychiatric acute treatment ward fee for acute care, the psychiatric long-term care ward fee for extended stays, the dementia treatment ward fee, and the child and adolescent psychiatric inpatient management fee.

The FY2024 revision created the psychiatric integrated community care ward fee to promote community transition in psychiatry. Like the general-bed integrated community care ward, it evaluates support for transition to home and community. In psychiatry, procedures under the Mental Health and Welfare Act, such as admission type (voluntary, medical protection, etc.) and records of behavioral restrictions, are closely tied to fee requirements, so record accuracy is especially important.

• Psychiatric ward inpatient basic fee: staffing grades from 10:1 to 20:1
• Acute: psychiatric emergency acute care fee, psychiatric acute treatment ward fee
• Long-term and specialized: psychiatric long-term care, dementia treatment, child and adolescent
• New in FY2024: psychiatric integrated community care ward fee

The care-mix model

A hospital operating wards with multiple inpatient fees is called a care-mix hospital. A 200-bed hospital with one acute general grade 4 ward, one integrated community care ward, and one long-term care ward is typical. Its strength is covering the continuum from acute admissions through home discharge support to long-term care within one institution, with patients transferred between wards as their condition changes.

Operating a care mix means simultaneously meeting different facility standards, documentation requirements, and bundling scopes per ward, which places a heavy management burden on both administration and nursing. Decisions such as which fee to bill on transfer and which add-ons continue arise daily. The EHR must allow flexible configuration of documentation templates and billing checks tailored to each ward's inpatient fee.

• Care mix: acute, recovery, and chronic wards within one hospital
• Strength: absorbs local inpatient demand across the continuum
• Challenge: managing different standards, records, and bundling per ward at once

How hospital and ward types affect EHR selection

Hospital and ward types strongly shape what an EHR must do. In acute general wards, whether severity and nursing-need evaluations can be aggregated automatically or semi-automatically from chart records determines nurse workload and billing accuracy. In DPC hospitals, support for DPC coding and preparation of Form 1 is essential.

In recovery rehab wards, recording ADL assessments such as FIM and BI, automatic calculation of the performance index, and support for rehabilitation plan documents are central. Long-term care wards need daily records that fully support medical and ADL category determinations, and psychiatric wards must manage admission type and behavioral restriction procedures in a legally compliant way.

Care-mix hospitals need the flexibility to run all of this in one system, switching by ward. In EHR selection, the starting point is to map which inpatient fees your wards register and how functions may change, then evaluate candidates against those requirements.

• Acute: nursing-need aggregation, DPC coding support
• Recovery rehab: ADL assessment records, automatic performance index, plan document support
• Long-term care: evidence records for medical and ADL categories
• Psychiatry: legal procedure records for admission type and behavioral restrictions
• Care mix: per-ward switching combined with unified management

Summary

Hospital and ward types are shaped by three overlapping axes: Medical Care Act classification, fee-schedule inpatient fees, and the four functions of bed function reporting. Everyday terms such as "acute hospital," "recovery rehab ward," and "care mix" mostly derive from inpatient fee names. Understanding this structure clarifies your hospital's position, its regional role, and what to expect from systems such as the EHR.

To repeat, point values and facility standards change with each revision. Figures in this article are reference values as of the FY2024 revision; verify changes in the FY2026 revision against MHLW notices and the latest fee schedule. The structure and mechanics of the inpatient fee itself are covered in detail in the companion article on the inpatient basic fee.