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2009年8月 5日 (水)


--The Asahi Shimbun, Aug. 4(IHT/Asahi: August 5,2009)
EDITORIAL: Nursing-care system

Have Ministry of Health, Labor and Welfare bureaucrats learned anything from the confusion over the medical insurance system for elderly people aged 75 and older? We cannot help but wonder, looking at the current situation.

Before they can receive nursing-care services under the public insurance scheme, all applicants must be screened and ranked according to how much care they need. Even though the standards for certification were just revised in April, the ministry has decided that many of them need revising again.

The April revisions were officially aimed at making the standards easier to understand so that there would be little variance across regions. However, before the revisions were implemented, many care managers and users expressed apprehension that the new standards would lower users' ranks.

When a user's rank is lowered, the insurance benefits paid to cover the service fees are also lowered. Users are understandably worried they will not be able to afford to pay for the services they need.

When the new standards were put to practice, as predicted many users were ranked lower than previously or were even declared ineligible for services. This happened despite the ministry's previous reassurance that since the opinions of family doctors would be taken into consideration, the revisions would not necessarily result in lowered ranks. It proved not to be the case.

When making the April revisions, the ministry also included exceptions so that users could remain at their same rank, even if judged at a lower rank under the new standards. But that makes screening for certification a meaningless effort, local governments complained. Why bother?

So the ministry now has no choice but to revise the standards again.

What caused all the confusion is the fact that the ministry forged ahead with the revisions in April without taking time to listen to users and care providers. The ministry also did not examine the situation adequately or make an effort to broadly inform those groups about the revisions.

Under April's revised standards, persons who need help putting on or taking off their trousers are judged as "needing assistance." However, people who wear adult diapers are categorized as "not in need of assistance." This is obviously wide of the mark. Such discrepancies could have been easily avoided if the ministry asked caregivers to help revise the standards. We urge the ministry to seriously reflect on this point.

The standards need to be reviewed and revised if necessary. However, in doing so, the ministry must not allow people in dire need of care to have their ranks lowered.

The degree of nursing care need should be determined based on factors such as how much time is required for the care. The ministry should continue to examine whether the proposed standards are in line with that standpoint.

Behind all the criticism is the ministry's continued efforts to curb rising social security spending. Critics are beginning to suspect that the ministry's efforts back in April were intended more to cut nursing-care expenses than to revise the standards and how they are applied nationwide.

The nursing insurance system, which is run with a limited budget, has led to various arguments. For example, how much care for less-needy people should be covered by insurance? Also, the system is supported by premiums paid by people aged 40 and older. Should that age bracket be changed?

The system was inaugurated nine years ago. How can it be operated in a sustainable manner, given that the number of its users will keep increasing? It is time for our political leaders to provide a broader vision of future welfare care.


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