小規模市町村における介護保険地域密着型サービスの運用―新潟県関川村と和歌山県由良町の事例から―

抄録

With the revision of the long-term care insurance system in 2006, new community-based services were established. However, these services are insufficient in small municipalities with populations under 10,000. Here we study two examples: (1) the village of Sekikawa in Niigata Prefecture, which has excellent services; and (2) the town of Yura in Wakayama Prefecture, which has no office of its own and instead receives wide-area services that cover the surrounding towns as well.

In Sekikawa, long-term care insurance services had traditionally been maintained both publicly and privately (such as day services and dementia patient care). Now these services, as well as the setup and structure of services for the long-term care insurance project, are being maintained according to the new administrative policy, mainly because these services are sufficient. However, with other projects such as hot springs falling under regional requirements, and with corporate management and individual actions of corporate executives being contributing factors, the high number of community-based services being set up in Sekikawa is clearly a highly fortuitous phenomenon.

In other words, putting services into effect in small municipalities is not purely the work of government administration. It also depends heavily on the participation of private business people. That being the case, the situation in Sekikawa cannot be said to be representative of small towns across the country. Accordingly, to gain a better sense of how these small municipalities’ services work in reality, the town of Yura in Wakayama Prefecture was studied. This town is the main focus of a community-based service office that serves multiple towns within a wide area.

The services offered by the office that serves Yura and the surrounding towns were accessed by only three people. This number is far lower than the number of people who utilized the services of the many offices serving the village of Sekikawa. For Yura, this goes beyond the scope of the utility of daily life and hardly constitutes anything resembling the idea of being ‘community-based’ for the locals.

What became clear from these two practical examples is that it is difficult for small municipalities to operate community-based services. Community-based services have strengthened municipal authority in supervising the assignment and direction of businesses more than the pre-existing long-term care insurance services had. Yet in municipalities where services are insufficient, administrative initiative is limited, and these towns cannot count on business contributions.