| 特集名 | 介護保険と透析医療 | |
|---|---|---|
| 題名 | 総論:欧米の介護制度 | |
| 発刊年月 | 2001年 12月 | |
| 著者 | 高橋 進 | 日本大学大学院グローバル・ビジネス研究科／国立横須賀病院名誉院長 |
| 【 要旨 】 | 一般に65歳以上の高齢者人口が全人口の12％になったときに高齢社会国と呼んでいる．高齢者人口が12％になったのはわが国や米国では1990年前後，フランスでは1960年である．欧米諸国でもわが国ほどでないにせよ，急速に要介護高齢者の介護対策・年金・福祉に対する措置が必要になっている．2025年にはわが国の高齢者人口は28.2％となり，フランスの23％をはるかに超えると推定されている． 制度体系上，ドイツ，日本が保険方式を，ドイツ以外のおもな欧州各国は税法式を採用している．米国は現在も医療保険での対応が中心で独立した制度はもたない． 最近，わが国の介護保険制度の基になったといわれるドイツでも少子高齢化が進み，要介護者が増え，1999年の連邦保険庁の収支暫定集計で支出が保険収入を上回り，約10億マルク(約560億円)の赤字が見込まれ，運営主体の介護金庫は積み立て基金を崩しており，制度発足5年で非常事態とのことである． 介護医療は要介護高齢者のADLおよびQOLの改善，さらに社会復帰のために施行されるものであり，家族介護人の労働力を節減してその労働力を生産性に向けることにも目標を置くべきである．しかし，どの国においても財政問題が頭痛の種であることは事実であるが，流れは医療から介護へのシフトや民間活力の導入といった財源の効率配分，市場原理の導入である． |
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| Theme | Curent Status and Problem of Long Term Care Insurance System for Dialyzed Patients | |
|---|---|---|
| Title | Long-term care system in Europe and USA | |
| Author | Susumu Takahashi | Nihon University Graduate School of Grobal Business |
| [ Summary ] | Western countries and especially Japan now need to take urgent measures to detail with healthcare issues, including pension plans and welfare for the elderly. At present, only three countries such as Germany, the Netherlands, and Japan have the public long term care insurance systems. Germany and the Netherlands have the public long term care insurances plans which were started in 1994. In Germany and the Netherlands, the governments have encouraged family care by providing the family with care subsidies, which has helped to cut care expenses government funded by half. This system has been working well until recently, however, a problem has arisen. Germany now has fewer young people and a higher number of older people, who are in need of long term care. According to the 1999 preliminary report of the German Federal Insurance Agency, expenses exceeded revenues from insurance premiums, resulting in approximately a DM 1 billion deficit. On the other hand, in the Netherlands, as well as Japan, the government is now trying the relieve families of the burden of long term care by encouraging the use of professional caretakers from public insurances or private companies. As a result, the expenses for these caretakers accounts for 5% of GDP. In France, health care is considered to be part of the welfare system, while in the US is considered to be a part of the medical system. In reality, each country has its only financial problems. |
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