The Saku Central Hospital started a joint undertaking for home health care with four village offices of Minamisaku-gun, Nagano Prefecture, from 1988. From 1995, the joint project was taken over by its satellite institution, Koumimachi Clinic. During the year, care services were provided in patients' homes by a full-time visiting nurse 665 times. She helped physical therapist with rehabilitation 228 times, attended many meetings related to health care with local people and public health nurses, and held case conferences about patients. The joint undertaking for home health care with local goverments may be important for better home health care.

Koumimachi Clinic attached to Saku Central Hospital is located in an underpopulated rural area. We have annually performed a close medical examination by upper gastrointestinal endoscopy since 1982. Since 1986, it has been done early in the morning. In 1995, a total of 1, 513 radiographic examinations were performed and 555 cases were examined by upper gastrointestinal endoscopy. Two cases of gastric cancer-one being early stage and the other, advanced stage-were detected. Despite the busy season all the farmers who had been advised to have the endoscopic examination attended because it was performed early in the morning. The early morning examination was performed in cooperation with Saku Central Hospital, Naganoken Kouseiren Health Screening Center, and public health nurses of local governments. Without such cooporation, any health care project could not be carried out a rural area.