Department of Health Services Research, Graduate School of Human Care Sciences, University of Tsukuba, Ibaraki, Japan.
Lancet. 2011 Sep 24;378(9797):1183-92. doi: 10.1016/S0140-6736(11)61176-8. Epub 2011 Aug 30.
Japan's population is ageing rapidly because of long life expectancy and a low birth rate, while traditional supports for elderly people are eroding. In response, the Japanese Government initiated mandatory public long-term care insurance (LTCI) in 2000, to help older people to lead more independent lives and to relieve the burdens of family carers. LTCI operates on social insurance principles, with benefits provided irrespective of income or family situation; it is unusually generous in terms of both coverage and benefits. Only services are provided, not cash allowances, and recipients can choose their services and providers. Analysis of national survey data before and after the programme started shows increased use of formal care at lower cost to households, with mixed results for the wellbeing of carers. Challenges to the success of the system include dissatisfaction with home-based care, provision of necessary support for family carers, and fiscal sustainability. Japan's strategy for long-term care could offer lessons for other nations.
由于预期寿命延长和出生率低，日本人口迅速老龄化，而传统的老年人支持体系正在逐渐瓦解。因此，日本政府于 2000 年推出了强制性的公共长期护理保险（LTCI），以帮助老年人过上更加独立的生活，并减轻家庭照顾者的负担。LTCI 采用社会保险原则运作，无论收入或家庭状况如何，都提供福利；在覆盖范围和福利方面都非常慷慨。只提供服务，不提供现金津贴，受益人可以选择自己的服务和提供者。对计划开始前后的全国调查数据的分析表明，家庭的正式护理费用降低，使用量增加，但照顾者的幸福感好坏参半。该系统成功面临的挑战包括对家庭护理的不满、为家庭照顾者提供必要的支持以及财政可持续性。日本的长期护理战略可能为其他国家提供借鉴。
