| 6. |
The
Comparison of the Elderly Care Expenditure in Both Countries |
| 6.1 |
The Ratio of Health Care Expenditure and Social Service Expend i ture |
The gap of the elderly care in both countries is so big. So in this chapter I analyze the difference between Sweden and Japan from the standpoint of the expenditure.
| Table.22 |
The Expenditure for the Social Service and Health Care for the Elderly |
|
Ratio of Health Care Expenditure |
Ratio of Social Service Expenditure |
Total |
| SWEDEN |
65 . 2%
(48.3 md SEK) |
34 . 8%
(25.8 md SEK) |
100% |
| JAPAN |
92 . 6%
(53.7 Billion Yen) |
7
. 4%
(5.1 Billion Yen) |
100% |
(Source:
|
Research of the Social Security Expenditure in 1989 by the Institute of Social Security in Japan.Ds 1989:27 p.169,”social
service and health care cost 65-w". Verksamhetsstatistik från SCB samt
landstingsforbundet publikationer om utskrivningsstatistik, bearbetade uppgifter) |
|
*1 SEK = 15 Japanese Yen (March in 1993) |
According to Table.22, we can understand that the Japanese old age care is too dominated by the health care service. One of the reasons of this imbalance comes from the "hotel function" of the hospitals in Japan. And another reason is that in Japan families usually provide the care (social service) for the elderly instead of the help by the municipalities. These care given by the families are almost free cost for the government.
And the ratio per GNP are as follows.
| Table.23 |
The Elderly Care Expendlture per GNP |
| |
Health Care Expend i tu re for
Elderly / GNP |
Social Service Expenditure for
Elderly / GNP |
Total |
| Sweden |
4.83% |
2.58% |
7.41% |
| Japan |
l.33% |
0.13% |
1.46% |
*
|
GNP in Sweden in 1989 was 1.044 md SEK
GNP in Japan in 1989 was 37,700.000 million YEN |
The definition of the "Health Care Expenditure for the Elderly" is different in both countries. In Japan it means the health care expenditure for the elderly over 70 years old and the health care expenditure for the bedridden elderly over 65 years old. But in Sweden it means the health care expenditure for the elderly over 65 years old. And the aging rate over 65 years old in 1989 was 12% in Japan and 18% in Sweden. So the health care expenditure for the elderly in Japan is more underestimated than in Sweden in this table. I can guess that the health care expenditure is about half than that of Sweden and the social service expenditure for the elderly in Japan is about one tenth than that of Sweden.
In 1991 total health care expenditure per GNP in Sweden is 8.4% and in Japan it is 6.6%. This expenditure includes nursing home's expenditure in Sweden also.
But if this statistic is adjusted by the aging rate, the total health care expenditure per GNP in Sweden and in Japan in 1991 is the same 8.4%(Source: SPRI informerar nr 3 1993). It means that if Japan had the same aging rate as Sweden, the total health care expenditure in both countries would be the same. So I can conclude that Sweden and Japan spend almost the same health care expenditure per GNP, but Sweden spends much more health care expenditure for the elderly than Japan does.
The Japanese care for the elderly is much cheaper than that of Sweden . But I must say that , in general, the QOL of the bedridden "elderly and senile dementia elderly and their
families are much lower in Japan than that in Sweden. Can man say that the Japanese care for the elderly is much more "effective" than that of Sweden? Absolutely not! Japanese Care for the Elderly is "worse and cheaper".
And if I include the pension expenditure, the table becomes as folIows ; ,
| Table.24 |
The Expenditure for the Elderly in Sweden and in Japan |
| |
Health Care Expenditure for elderly / GNP |
Social Service Expenditure for elderly / GNP |
Pens i on / GDP ( 1988
) |
Total |
| Sweden |
4 . 83% |
2 . 580% |
14 .5% |
21 . 9% |
| Japan |
1 . 33% |
0.13% |
7 . 3% |
8
. 8% |
From this table it can be said that the gap about the
social service expenditure is the biggest and this gap can be explained that
comes from the informal care by the families in Japan.
| Table 25 |
The Expenditure Ratio in Different Field
|
| |
JAPAN ( 1990 ) |
SWEDEN ( 1985 ) |
| Old Age Home Nursing Home Geriatric Hospital |
20.7% |
40% |
| Hospital Care |
77.50% |
35% |
| Home Helper Home Health Care Family Assistance |
1.8%* |
13% |
| Housing Allowance |
- |
8% |
| Housing Adjustment Technical Aid |
- |
- |
| Sheltered Housing |
- |
2% |
| Others |
- |
2% |
| Source: |
Aldreomsorg i Norden -kostnader,kvalitet ,styrning |
| STATSKONTORET 1987:34 |
|
Ministry of Health and Welfare in Japan |
| in Japan : |
Old Age Homes and Nursing Homes (400 bil YEN) |
| |
Geriatric
Hospital
( 7, 400 bil YEN) |
| |
Hospital Care (42,600 bil YEN) |
| |
Home Care (l00 bil YEN) |
| *
|
1.8% is only the expenditure for the home helpers.
|
| In Japan district nurse system just started in 1992 and the home-visit by the doctor is not so common. There are many medical clinics in Japan and the expenditure of such medical clinic is included by the hospital care in this table. |
In Japan, the family assistance is cheap. The family-care-givers who take care of the bedridden elderly at home can get only 50,000 YEN(3,333 SEK) per month.
| Table.26 |
The Ratio of the Elderly(>65) who Get the Following Service |
| |
JAPAN ( 1989 ) |
SWEDEN ( 1985 ) |
| Hospital |
-* |
2% |
| Old Age Home Nursing Home Geriatric hospital |
2% |
7% |
| Day Service Lunch Deliver |
0.5% |
4% |
| Sheltered Housing |
|
3% |
| Home Helper |
2.5% |
14% |
| Home Health Care |
-** |
3% |
| Transport Service |
|
21% |
| Housing Allowance |
|
33% |
| * |
No statistic. |
|
** |
The district nurse system just began in 1991 and the home health care is not so commnon in Japan. |
|
(Source: the same as Table.25) |
As I have showed in this chapter, Japanese elderly
care system is too dominated by the hospital care. The reasons are as follows:"
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