Matsuda Shinya
Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan.
Aging Clin Exp Res. 2002 Aug;14(4):265-70. doi: 10.1007/BF03324449.
Japan implemented a new social insurance scheme for the frail and elderly, Long-Term-Care Insurance (LTCI) on 1 April 2000. This was an époque-making event in the history of the Japanese public health policy, because it meant that in modifying its tradition of family care for the elderly, Japan had moved toward socialization of care. One of the main ideas behind the establishment of LTCI was to "de-medicalize" and rationalize the care of elderly persons with disabilities characteristic of the aging process. Because of the aging of the society, the Japanese social insurance system required a fundamental reform. The implementation of LTCI constitutes the first step in the future health reform in Japan. The LTCI scheme requires each citizen to take more responsibility for finance and decision-making in the social security system. The introduction of LTCI is also bringing in fundamental structural changes in the Japanese health system. With the development of the Integrated Delivery System (IDS), alternative care services such as assisted living are on-going. Another important social change is a community movement for the healthy longevity. For example, a variety of public health and social programs are organized in order to keep the elderly healthy and active as long as possible. In this article, the author explains on-going structural changes in the Japanese health system. Analyses are focused on the current debate for the reorganization of the health insurance scheme for the aged in Japan and community public health services for them.
日本于2000年4月1日实施了一项针对体弱老年人的新社会保险计划——长期护理保险（LTCI）。这是日本公共卫生政策史上的一个划时代事件，因为这意味着日本在改变其传统的家庭养老模式，朝着社会化养老迈进。建立LTCI背后的主要理念之一是使老年人护理“非医疗化”并使其合理化，这些护理是老龄化过程中残疾老年人所特有的。由于社会老龄化，日本社会保险体系需要进行根本性改革。LTCI的实施是日本未来医疗改革的第一步。LTCI计划要求每个公民在社会保障体系中承担更多的财务和决策责任。LTCI的引入也给日本医疗体系带来了根本性的结构变化。随着整合式医疗服务体系（IDS）的发展，诸如辅助生活等替代性护理服务正在不断推进。另一个重要的社会变化是促进健康长寿的社区运动。例如，组织了各种公共卫生和社会项目，以使老年人尽可能长时间地保持健康和活跃。在本文中，作者解释了日本医疗体系正在发生的结构变化。分析重点在于当前关于日本老年人医疗保险计划重组以及为他们提供的社区公共卫生服务的辩论。
