Rehabilitating the care system
(From The Japan Times April 21 issue)

介護保険制度の改革

    The individual municipalities or associations of municipalities that have been operating the insurance system will play an important role in the new approach. Efforts and creative thinking are called for to provide easy-to-use services, which will be welcomed by the elderly members of local communities.

    At present, some 4 million out of the nation's 25 million people aged 65 or older are designated as beneficiaries who need the system's care, double the corresponding figure in fiscal 2000, when it was inaugurated. Such a significant increase suggests that the services provided by the system are being used not only by people who really need intensive care but by those whose conditions are not so serious.

    An increase in available services has spawned a number of problems. Some people have begun to use wheelchairs although they can walk, and others have come to completely rely on helpers for household chores, including preparation of meals, even though in reality they are capable of doing some housework themselves. Such unnecessary practices increase the financial burden placed on the insurance system. Total spending of the nursing-care insurance system is expected to climb from the ¥3.6 trillion in fiscal 2000 to ¥7.1 trillion in fiscal 2006.

    To correct the situation, the government has created two new "needing support" categories in addition to the five "needing care" categories for beneficiaries of traditional nursing-care services. Some beneficiaries whose conditions are not serious will be reclassified from the "needing care" categories into one of the "needing support" categories.

    Those in the "needing support" categories will not receive certain traditional nursing-care services. For example, they will not be provided with wheelchairs or automated beds under the insurance system. Instead they will receive "preventive" services that are aimed at keeping elderly people healthy. The hoped-for final result is an increase in healthy elderly people and a reduction in the insurance system's total spending, which would in turn create surplus funds that can be used to provide better care for those elderly people who have serious health problems.

    The newly created preventive services include exercise training to strengthen muscles, training to increase masticatory strength and nutritional counseling. Services are provided depending on the conditions of individual beneficiaries. Household-chore help is limited to elderly people who live alone, and those who receive it will have to participate in meal preparation and housework with the helpers. There is a cap on the cost of these new services — either about ¥50,000 or ¥100,000 a month, depending on the beneficiary's conditions and needs, and beneficiaries will have to pay 10 percent of the cost. The Health, Welfare and Labor Ministry estimates that 1.6 million people will start receiving the new services.

    Municipalities have established or will establish support centers as the hubs of preventive services. They are expected to number 5,000 to 6,000. Public-health workers will draw up care plans for those who receive the new services. Because the new services have just started, municipalities need to give full explanations to beneficiaries and their family members to avoid confusion. They need to listen to their opinions with an eye on improving the quality of services.

    As the graying of the population progresses, steps are being taken to ensure the nursing-care insurance system remains financially viable, including raising the premium from April 1. For people aged 65 or older, the monthly premium increased 24 percent to ¥4,090. For people in the age bracket of 40 to 64 it rose 5.6 percent to ¥1,982. The survival of the system is all the more important because postwar baby boomers will reach the age bracket of 65 to 74 in 2015. The number of those 65 years of age or older will peak at 35 million in 2025. It is expected that households consisting of one person or a married couple will account for 60 percent of all elderly households in 2015. The number of elderly people with senile dementia is projected to reach 2.5 million the same year, double the current figure.

    It is becoming imperative for the government and the private sector to engage in debate, and try to reach a consensus on what kinds of services should be provided under the nursing-care insurance system as well as who should pay and how much.

The Japan Times Weekly: April 29, 2006
(C) All rights reserved

    現在、65歳以上の高齢者2500万人のうち、約400万人が介護認定を受けており、2000年の制度発足時の2倍に増えている。この中には、介護保険のサービスをあまり必要としない人たちも含まれている。歩けるのに車椅子を使っている人、実際は家事ができるのに、ヘルパーに依存している人たちもいる。

    介護保険給付費は、2000年の3兆6000万円から、06年には7兆1000万円に増える見込みだ。

    問題是正のため、政府は従来の要介護認定5段階に加え、要支援認定2段階を新設した。要支援に認定された利用者は、筋力トレーニング、栄養改善などの介護予防サービスを受けられる。

    家事援助サービスを受けられるのは1人暮らしの高齢者に限られるが、利用者も調理などの家事に参加することを求められる。利用できる限度額は月額約5万円または10万円で、自己負担はその1割になる。

    全国の自治体は5000〜6000カ所の介護予防センターを設置し、保健師が利用者のためにケアプランを作成する。

    介護保険の財政悪化を防ぐため、同じく1日から保険料が65歳以上の被保険者については月額4090円（24％増）、40〜64歳の被保険者については1982円（5.6％増）となった。

    人口の高齢化に伴い、介護保険の財政安定化は今後ますます重要になる。

    2015年には団塊世代が65歳〜74歳になり、2025年には65歳以上の人口が3500万人で頂点に達すると予想される。2015年には、高齢者世帯のうち1人世帯、2人世帯が60％を占めると予想される。

    政府、民間部門は、介護保険のサービスの内容、費用分担について議論を進め、合意に達することが求められる。