Abstract
One of the issues selected is the consideration of the establishment of a medical system for the elderly from the perspective of the patient, and the handling of terminal care for the elderly and the effects on medical costs are examined. Terminal care through hospice programs has been being introduced in Japan since the 1990s, but it is hard to claim that it has become well established in society. Medical professionals have a greater awareness than the general public about selecting hospice as the form of assisted care.
It is pointed out that even economic inducements, such as “assisted care ward admission fees”and “general medical fees for in-home terminal treatment”through medical reimbursements have not had a large impact, even with increasing numbers of cancer patients and elderly persons living at home. It is emphasized that the proportion of medical costs spent on terminal care treatments is not that large, and the importance of quality of life (QOL) of the elderly as well as the appropriate allocation of resources to achieve this is clarified. Future issues include the following: (1) There is no way to verify the current confusion and intent of the elderly with regard to terminal care, so p rudent discussion is necessary to handle extreme arguments. (2) More so than the terminal care, there are problems with increasing medical costs due to long-term care of elderly patients, including hospitalization. Priority must be placed on reviewing the long-term medical care of elderly patients as well as on resource allocation (= methods of reimbursements for medical examinations and treatments). The issue of terminal care should be discussed after these other points are considered. (3) The medical system for the elderly is concerned with questions about how to respond to the wide range of views on health, and opinions about life and death of people who have lived long lives. The concepts of uniformity and equality that generally form the basis of the systems we build cannot be applied, and efforts are being made to devise solutions for these difficult problems.
