Care-needs certification in the long-term care insurance system of Japan
Care-needs certification in the long-term care insurance system of Japan
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DOI：
10.1111/j.1532-5415.2005.53175.x
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发表时间：
2005-03-01
影响因子：
6.3
通讯作者：
Muramatsu, N
中科院分区：
文献类型：
--
作者：
Tsutsui, T;Muramatsu, N
日本于2000年4月引入长期护理保险制度，使长期护理成为严格基于身体和精神状况的每个65岁及以上日本人的明确和普遍的权利。在该计划开始时，预计将有200多万老年人向大约3000个市政府申请服务，这些政府是LTCI保险公司。LTCI的实施需要一个全国标准化的需求认证系统，以客观、公平和有效地确定服务资格。目前的计算机辅助初始需求评估工具是根据对长期护理机构的专业护理人员进行的大规模时间研究收集的数据开发的。随后，在LTCI开始之前，通过评估参与国家示范项目的175,129名老年人的数据，对该工具进行了测试和验证。计算机辅助初步评估(85个项目的问卷)用于将每个申请者分配到七个需要级别中的一个。护理需求认证委员会是一个由医疗和其他专业人员组成的委员会，负责审查结果。在实施三年后，长期合作伙伴关系制度及其需求评估/认证制度在日本得到了很好的接受。尽管总体上取得了成功，但仍然存在挑战，包括地区差异、对服务的日益增长的需求，以及保持需求认证不受政治影响的困难。将市政当局和中央政府联系起来的LTCI计算机网络有助于不断改进需求认证系统。未来的挑战包括促进基于证据的系统改进，并在系统中为不同选区建立激励机制，以促进老年人的功能独立。
The introduction of Japan's long-term care insurance (LTCI) system in April 2000 has made long-term care an explicit and universal entitlement for every Japanese person aged 65 and older based strictly on physical and mental status. At the start of the program, more than two million seniors were expected to apply for services to approximately 3,000 municipal governments, which are the LTCI insurers. The LTCI implementation required a nationally standardized needs-certification system to determine service eligibility objectively, fairly, and efficiently. The current computer-aided initial needs-assessment instrument was developed based on data collected in a large-scale time study of professional caregivers in long-term care institutions. The instrument was subsequently tested and validated by assessing data of 175,129 seniors involved in the national model programs before the start of LTCI. The computer-aided initial assessment (an 85-item questionnaire) is used to assign each applicant to one of seven need levels. The Care Needs Certification Board, a committee of medical and other professionals, reviews the results. Three years after implementation, the LTCI system and its needs-assessment/certification system have been well accepted in Japan. Despite the overall successes, there remain challenges, including area variations, growing demands for services, and the difficulty of keeping the needs certification free of politics. The LTCI computer network that links municipalities and the central government is instrumental in continuously improving the needs-certification system. Future challenges include promoting evidence-based system improvements and building incentives into the system for various constituencies to promote seniors' functional independence.