Abstract
The focus of demand for medical care is shifting substantially toward elderly people, due to the rapid advance of the super-aging society, so a paradigm shift is required in approaches to medical care and the provision thereof.
The 20th century was a time of great progress and achievement in the evolution of curative medicine. Curing involves finding and removing the cause of organ damage. Until we reach our 60s, diseases tend to take the form of a single problem in a single organ, so there was high demand for curative medicine. However, in the 21st century, now that the average life expectancy is in excess of 80 years of age, most medical demand is focused on chronic systemic diseases, in which lifestyle-related diseases complicate the aging process.
If we try to cure a single problem in a single organ without giving consideration to achieving an appropriate balance with the rest of the body, problems can emerge in maintaining the harmony between the system as a whole and the functions of individual organs, which can exacerbate issues with the patient’s general condition. Accordingly, medical care for elderly people needs to focus not simply on curing people, but on shaping and supporting their ability to take care of themselves, so that each person can live the life they want.
Another issue is the paradigm shift away from hospital-centered medical care to community-centered medicine. In Japan, we have built a system for the provision of medical care in which everything from birth through to death takes place in a hospital. This has been supported by the system of universal insurance, but its limitations have now come into stark focus.
In future, based on an understanding that there are limits to both financial resources and service provision, we will need to change to a more effective, efficient medical care system, in which hospitals specialize in the functions that only hospitals can offer, and medical and nursing care are provided in the community as a whole in an integrated manner.
