Public long-term care insurance in Japan
Public long-term care insurance in Japan
复制标题
DOI：
10.1001/jama.278.16.1310
复制
发表时间：
1997-10-22
影响因子：
120.7
通讯作者：
Ikegami, N
中科院分区：
文献类型：
--
作者：
Ikegami, N
一项公共长期护理(LTC)保险计划可能于2000年引入日本。关于在迅速老龄化的社会中需要更多长期培训资源的共识，以及对现行制度的不满，是促成该制度出台的一些因素。一半的费用将由对所有40岁以上的人征收的保费支付，另一半将由一般税收支付。保险公司将是在国家一级拥有汇集机制以平衡其人口结构差异的市政当局。福利将包括机构护理、暂缓护理、日间护理、家务助理、探访护士和设备租赁。资格状态将被分为6个级别，这将由功能和认知状态的评估来确定。然而，几乎没有机制来限制收益和控制成本。在资格分类的设计和评估工具方面也存在问题。拟议的长期医疗保险制度突出表明，有必要界定长期医疗保险“基本方案”中应包括的内容，以此作为每个公民的一项权利；需要一种组织机制和评估工具，以有效和公平地提供服务；需要医生在传统医疗模式之外工作。日本公众，尤其是医生，在多大程度上愿意处理这些问题，是21世纪的一个挑战。
A public long-term care (LTC) insurance program is likely to be introduced to Japan in the year 2000. A consensus on the need for more LTC resources in the rapidly aging society and dissatisfaction with the current system are some of the factors that have contributed to its introduction. Half the costs will be paid by premiums that will be levied on all those older than 40 years, and half will be covered by general taxation. The insurer will be the municipalities with a pooling mechanism at the national level to balance the differences in their demographic structure. The benefits will include institutional care, respite care, day care, home help, visiting nurses, and loan of devices. Eligibility status will be classified into 6 levels that will be determined by assessment of functional and cognitive status. However, there are few mechanisms to limit benefits and contain costs. Problems also exist in the design of the eligibility classification and in the assessment instrument. The proposed LTC insurance system highlights the need for defining what should be included in a ''basic package'' of LTC as an entitlement for every citizen, for an organizational mechanism and an assessment instrument to deliver services efficiently and equitably, and for physicians to work outside the traditional medical model. To what degree the Japanese public in general, and physicians in particular, is willing to deal with these issues is a challenge for the 21st century.