Sociological Comparative Study on Community Care Systems

1. 在当代日本社区，社区护理系统不能以同样的形式构建。因此，有必要选择比较的方法来分析这些系统。(1)在农村地区，可以观察到乡镇特色社区护理体系的建立。（例如，长野县的安冈村、武石村、小川村）在这些情况下，许多提供老年人护理服务的行动者合作，医疗机构领导这种合作。在这种情况下，在这些乡村医院工作的医生高度关注社区保健，并努力构建社区保健体系。(2)城市社区护理体系建设困难。在这些地区，提供养老服务的主体数量非常庞大，主体之间的合作并不容易。但是，私立医院主导社区保健体系建设的事例（东京仙州地区）是存在的。(3)孤岛地区社区护理体系建设困难。在这些地区，社区医学的一个最重要的问题是拯救病人。在这种情况下，医生和官员主要关心的是改善医疗条件。但有一个社区居民试图构建社区护理体系的案例（冲绳县竹美镇的初间岛）。医疗部门对于构建社区医疗体系非常重要。(1)医疗机构参与社区护理体系的必要性。医生们接受护理比治疗更重要的观念是可取的。(3)医疗部门有可能破坏建立社区医疗体系的机会。但医疗部门也可以改变这些情况。

1. In contemporary Japanese communities, community care systems cannot be constructed in the same form. Therefore, it is necessary to select a comparative approach in order to analyze these systems.2. (1) In rural areas, it can be observed that characteristic community care systems are built in villages and towns. (Ex. Yasuoka village, Takeshi village, Ogawa village in Nagano prefecture) In these cases, a lot of actors which supply care service for the aged cooperate, and medical institutions lead this cooperation. In these cases, medical doctors who work in hospitals of these villages highly concern community care and they endeavor to construct community care systems.(2) In urban areas, it is difficult to build community care systems. In these areas, amount of actors which supply care service for the aged is very huge, so these actors cannot cooperate easily. But there is a case in which a private hospital leads construction of a community care system (Senju area in Tokyo).(3) In areas of isolated islands, it is difficult to build community care systems. In these areas, a most important issue of community medicine is to save patients. In these circumstances, medical doctors and officers are mainly interested in improvement of medical conditions. But there is a case in which residents of a community try to construct a community care system (Hateruma island in Taketomi town in Okinawa prefecture).3. A medical sector is very important for constructing community care systems.(1) It is necessary for medical institution to take part in community care systems.(2) It is desirable for medical doctors to accept a idea that care is more important than cure.(3) It is possible for a medical sector to destroy a chance to build community care system.But a medical sector also can change these circumstances.