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The Care for the Elderly in Sweden and in Japan |
In Japan the finance of the social service is by the tax, but the finance of the health care is by the national public medical insurance . In Japan the national health insurance system was started in l 9 6 1 , and aII people a re covered by some type o f medical i nsurance .National medical expenditures are paid by premiums, publ i c money and patients , and i s cont i nuousIyincreasing . Growth in the cost treatment of the elderly is particularly great. Medical treatment expenditure per elderly person is five times larger than per young person. It is easy for the Japanese Ministry of Health and Welfare to increase the expenditure of the health care than that of the social service, because it is easier to rise the borne of the medical insurance than to rise the tax. In 1990, the national medical treatment expenditure is 20,607 Billion Yen and the Borne by insured persons is ll,254(55%), borne by insurance system for the elderly is 5, 764(27%) ,borne by patients is 2,488(12%) and borne by public funds is 1, 100(6%) . In 1984 the number of the beds at the geriatric hospitals(all of them are private bodies) was 74,810, but in 1991 it spread to 151,905 beds. This means that it was easier for the Japanese Ministry of Health and Welfare to build geriatric hospitals than to build nursing homes. One of the reasons were it was easier to increase the health care expenditure than the social service expenditure . And there is a mental reason also. When elderly people become a little handicap, to depend on the social service(welfare) seems to be shameful in Japan. Because social service is supposed to be only for the poor people in Japan. If the family care-givers let their elderly patients stay at the nursing homes(glderdomshem in Swedish), the family care-givers would be criticized by the neighborhood people or relatives as follows; "Family must have the responsibility to take care of their elderly! " . But to depend on the health care is not shameful at all, because Japanese people understand that the family care-givers can not take care of the "sick" elderly at home. As a result, more and more family care-givers want their elderly stay at the geriatric hospitals than at the nursing homes. Moreover it is "cheaper" for the family that the elderly become sick than they become handicap. The following figure is the cost of the different location of the bedridden elderly.
Table . 27 (10.000 Yen / Month)
*(10.000 Yen = about 660 SEK)
This table can be explained as follows;
So I can conclude that the medical insurance system is the basic problem of the imbalance of the health care expenditure and the social service expenditure. In fact, the need the official insurance system f or the social service ( eIderly care ) i s discussed in Japan now. Because by the integration of the finance between the health care and the social service, the integration of service between the health care and the social service would be possible. This is not only the problem in Japan, but also the structural problem in U.K. and in Germany which have the similar medical insurance system. In U.K. and in Germany the elderly care depend too much on the health care like in Japan (Ref. First Annual Report of the European Community Observatory -SociaI And Economic Policies and older people -). And in Germany the official care insurance is planed to introduce in near future. My opinion is that the Japan also should introduce the official |
