介護保険制度改正に伴う市町村の権限拡大と地域への影響―神奈川県藤沢市の事例―

抄録

Citing Fujisawa City, Kanagawa Prefecture as an example, this manuscript clarifies the changing authority and roles of municipalities resulting from the introduction of the long-term care insurance system. Additionally, it looks at the influence that this has had on long-term care insurance services, as well as on the region.

The city did not become directly involved in the provision of long-term insurance care services associated with the April 2000 introduction of the long-term care insurance system. Furthermore, the entry of private business into this area has accelerated, and long-term care facilities have increased to a greater extent than municipal planning had targeted. This means that the municipality cannot effectively regulate the provision of long-term care insurance services.

Subsequently, in April 2006, the long-term care insurance system was drastically revised. Municipal authority over the establishment of a comprehensive support center for the community, community-based services, etc., was greatly enhanced. This has been reflected by the municipalities advancing into the area of construction of community comprehensive care systems. However, regional control, which centers on the municipalities in the midst of the mainstream trend of neo-liberalism in public service outsourcing, has become a difficult situation. It is necessary to reexamine this municipal involvement in long-term care services, which has resulted from the expansion of municipal authority through the movement towards regional decentralization.

Thus, the author considers that regional gaps in the provision of long-term care services can be largely attributed to municipal policies, ideas, and financial conditions, following the expansion of municipal authority. However, it is likely that if municipalities are more likely to outsource services based on neo-liberalism, the aging situation, and the industrial structure related to service providers’ market entry activities, will be primary factors in regional gaps in long-term care insurance services.