This is the first time that Journal of Health Care and Society gave a trial to publicly call for papers in a specific theme. As a result, this volume is completed with seven outstanding papers featuring“Geriatric Medicine and Long-term Care for Elderly in Japan”. Authors of the these papers are excellent health care talents actively participating in this area, as well as trained researchers capable of generalizing and writing through their experience and observation of the field.
In my introductory paper about long-term nursing care in th i s country, I explain the significance of creating the new social insurance system for long-term care. There are three arguing points:
1. What is the essential val ue of social insurance for long-term nursing care?
2. What are the differences between the current plan in Japan and ideal insurance system described in Part 1?
3. Why should we still implement th e insurance system even though which is not-so-ideal?

View full abstract

Social Insurance of Long Term Care for the Elderly is one of the most important reform of the social security system in Japan after the world war II. In this new system,“Care Management”is being adopted as new method for integlation of various medical and social services to each client.
This method is inducing to provide appropriate and equal services for eligible client which is so to say“informed concent of social service”: Successful realization of this is the determinant factor which people estimate this new system as satisfied one or not.
Part I makes clear the back ground of emerging this new method, Part II discusses about new two techniques to evaluate client's needs.

View full abstract

Policies regarding care services and facilities for the aged in Japan, including services offered in the home, are based on the 1963 Welfare Law for the Aged, the 1982 Health and Welfare Law for the Aged, and the 1990 revisions to eight welfarerelated laws.
This paper intends to analyze functional relationships among different supportive care facilities for the aged which had been consolidated meeting the needs of the times.

View full abstract

Cataract surgery, a common procedure performed on elderly, differs from ordinary medical procedures in that it dose not follow characteristics of health services defined by classical theory of health economics. Since it is elective surgery performed primarily to improve quality of life rather than lifesaving porposes, the rate of surgery is heavily influenced by financial factors.
Inclusion of intraocular lens into insurance coverage. in '92 caused a fluctuation of the growth curve by provoking deferment and preemption of services in the surrounding years. However it did not appear to have affected the cumulative volume of services contrary to a claim that many elderly were deterred from having surgery because of financial restraints. Careful, evidence-based research is necessary when making a decision on inclusion of such an elective, price elastic procedure into insurance coverage.

View full abstract

Would enforcement of social long-term care insurance create a truly attractive market ?
What should be done in order for private profit enterprises to grow up ?
Here is my verification of what kind of roles private commercial enterprises are expected to fill for the future.
Home-health-care market has following features.
1) characteristics of merchandise: ineffective if various functions are not combined combined
2) characteristics of users: isolated from information
3) market scale: indistinct boundaries
4) its growth is extremely promising
5) highly competitive Therefore, the development of new merchandise and services that serve the needs of users make private profit enterprises possible to ensure an extremely big market share.
However, it is necessary to let every supplier permit in condusting the management of nursing care, not limiting the participation to some, in order to create good private profit enterprises.
That is, private commercial enterprises must develop new merchandise. and services positively as well as be able to make high level nursing-plan in supplying services.

View full abstract

As the size of the elderly population increases, the need for a variety of new quality elderly care services has also grown. To meet these growing needs, the private sector and the public sector will have to work together.
This new industry is still in its early stages of development, primarily because:
1. The public is still largely unaware of the new services being offered by business.
2. These new services compete with the long-standing subsidized, and therefore lower-priced public sector services.
3. These new companies frequently lack management experience and adequate resources. This new industry must learn how to compete in the marketplace independently, in order to survive. However, the strategic support must be done in a systematic manner by the government. This can be done by both demonstrating the potential size of this market to companies in order to increase interest in participating, as well as clearing away barriers to entry such as subsidized lower priced public services.
The first half of this paper is devoted to defining the needs of our aging society, and assessing how much of this demand can be satisfied by current government services. The part of the demand currently unmet, represents minimum size of the new private sector opportunity. In the second half, we also try to define how much the expected consumer cost from the establishment of the new elderly care insurance system will increase this demand.
Participation of private industry will be required to meet the growing needs of the elderly. It must be given an opportunity to compete fairly with existing public sector, in order to flourish under the new elderly care insurance system.

View full abstract

Danish and British home care systems for the demented elderly are critically reviewed. In both countries similar care systems are found: The elderly people with dementia are cared for at home by generic home care services provided as a social service as long as their dementia is mild and as long as they do not show any troublesome behaviors like anxiety, hallucination, delirium, excitation, etc. When dementia becomes too severe for the generic home care quantitatively or qualitatively, psychogeriatric interventions are initiated and the demented elderly may be moved to a nursing home, admitted to a hospital or placed under control of psychogeriatric community care. In neither Denmark or Britain are contributions from geriatricians to the home care of the demented elderly significant.
The following problems were found in both countries.
1) basic difference of approach between dementia care and generic home care: in generic home care, emphasis is focused on functional disabilities of the client, which are provided by home care staff. In dementia care, modern approach puts emphasis on the improvement of independence of the patient.
2) importance of medical evaluation of dementia: considering the fact that some dementias are treatable, specialist referral system should be available and home care staff, who are in a good position to find the elderly with very mild dementia in its early stage, need some education on dementia to find and refer these elderly.
3) dementia home care as coordination between medical and social services: both in Denmark and in UK, there are some barriers between the social department, to which generic home care belongs, and the health care department, to which psychogeriatric care belongs. These barriers may derive from the political, cultural and historical differences between these two departments in both countries. We may have similar problems in Japan and these may need further study.4) family support: in the above described care system for the demented eldery, the role of family is important especially in early stages of dementia. Furthermore, the burden of family care is considerable so that social relief of the burden is necessary.

View full abstract

The 10th International Conference on AIDS was held in Yokohama City in August,1994. Before and after the Conference, we conducted two anonymous completed questionnaires. The object of this paper is to clarify such questions as 1)whether people recognize the problem of HIV/AIDS as their own concern,2) what kind of proper knowledge should be provided for the prevention of HIV/AIDS,3) a way to live with HIV/AIDS if we were infected with HIV/AIDS,4) the better way we can live with the people who have HIV/AIDS. To achieve this objective, we focused on the case of the senior population.
As a result of our survey, we received the following three results.1) Most campaigns about HIV/AIDS did not reach the senior population, because the significant emphasis on technical matters regarding safe sex.2) The knowledge for the prevention of HIV/AIDS included not only a medical one, but also a“life consciousness”connected with social value.3) More campaigns should be carried out among differing social groups.

View full abstract

The main purpose of this paper is to clarify critical determinants of social welfare expenditure for the elderly in local government in Japan. In general, as reasons why the amount of social welfare expenditure increased; 1) the rapid increasing of elderly generation, and 2) recent improvement of action in national policy for elderly people are considered. However, it is also claimed that 1) cutting down in the ratio of national contribution to local government, on the one hand, encourages them to be more autonomous in budget allocation, and, on the other hand, may cause an undesirable budget shortage to perform some important public elderly care program, and 2) there is, what is called,budget incrementalizm in deciding their budget to keep desirable size of pie.
I empolyed the regression estimation to find the most critical factor which influence the amount of social welfare expenditure by using macro and micro local government settlement acount data.
The result of my estimation are as follow; 1) no definite influence of cutting of national contribution on the amount of expenditure was found,2)budget incrementalizm in public expenditure was statistically significantly observed, and 3) relationship between a magnitude of residential needs for the elderly care and an amount of settled account seemed not to exist.
Considering an expected and a various increase in requirment of elderly care needs in advanced aging society, the budget incrementalizm observed in local finance policy is not expected. It is sure to be important to install the incentive mechanism into the process of deciding the budget in local government and disbursing national contribution to fit the needs.

View full abstract