The long term care insurance law in Japan: impact on institutional care facilities
The long term care insurance law in Japan: impact on institutional care facilities
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DOI：
10.1002/gps.818
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发表时间：
2003-03-01
影响因子：
4
通讯作者：
Yamada, Y
中科院分区：
文献类型：
--
作者：
Ikegami, N;Yamauchi, K;Yamada, Y
背景2000年4月1日，日本开始实施公共长期护理（LTC）保险，将原来由卫生部门和社会福利部门分担的资金统一起来。所有65岁及以上的老年人都有权根据其资格水平领取福利金，而不论其收入或家庭支助如何。除了那些被评估为最不依赖的群体外，个人可以选择社区护理或机构护理，只有食物的费用是对后者的额外支付。方法回顾老年人长期护理保险的发展和影响，并根据居民水平数据进行质量分析。新方案对机构照料提供者的影响微乎其微。提供长期护理服务的三类设施继续独立运作，基本上维持相同的人手需求和收费。调整风险的指标，护理质量往往较高，在指定的LTC hospital beds.Conclusions机构和社区护理之间的适当平衡和三种不同类型的设施之间的分流仍然很困难，因为决定休息与个人。质量指标必须考虑到各类设施在病例组合方面的差异。然而，由于需求可能越来越大于供应，供应商几乎没有提高质量的动力。新方案的慷慨规定是否能持续下去，还有待观察。版权所有（C）2003约翰威利父子有限公司。
Background Following the introduction of the public long-term care (LTC) insurance in Japan on 1 April 2000, funding that had been split between the health and social welfare sectors was unified. All elderly people 65 and over have become entitled to receive benefits according to their eligibility level, regardless of income or family support. Except for those assessed as in the least dependent group, individuals can choose either community care or institutional care, with only the cost of food an additional payment for the latter.Method Review of the development and implications of long term care insurance provision for older people and analysis of quality based on resident level data.Results Despite the structural changes, the impact of the new programme has had minimal impact upon the providers of institutional care. The three types of facilities that had provided LTC have continued to function independently, basically retaining the same staffing requirements and charges. For indicators adjusted for risk, the quality of care tended to be higher in designated LTC hospital beds.Conclusions Appropriate balance between institutional and community care and triaging among the three different types of facilities remains difficult because decisions rest with the individual. Indicators of quality must take into account differences in case-mix among the facility types. However, there are few incentives for providers to improve quality because demand is likely to be increasingly greater than supply. Whether the generous provisions of the new programme will prove to be sustainable remains to be seen. Copyright (C) 2003 John Wiley Sons, Ltd.