The Ministry of Health and Welfare has tried to encourage private elderly care. And the need of the private service will become bigger and bigger. So it is clear that the elderly care by the private body will be much more active in the future.

But through the experience of the private elderly care -both business catering and voluntary organizatioy- for the last ten years, I don't think that the elderly care by the private body can not be the initiative of the elderly care, because there are three limitations. 

I have visited some private retirement homes and private nursing homes in U.S.A. And in U.S.A. middle-class elderly also stay at the private facilities. There are two big reasons why i n U . S . A . middle-class elderly can stay at the private faciIities .

The first reason is that the priceis not so expensive . Because the personnel expenses and construction costs are cheap in U.S.A. The majority of the care stuffs are immigrants from Mexico South America and Philippine and so on

The second reason is that the health insurance( "medicare" ) and social insurance ( "medicaid " ) pay the cost f or the pri vate facilities, when the elderly become bankrupt.

But in Japan, situation is very different. The personnel expenses and the construction costs of the facilities are very expensive . Particularly land price is extremely expensive in Japan. And the national medical insurance does not pay the cost for the private facilities.

So in Japan, it is almost impossible to build the cheap private faciIities .And business catering home help service is also expensive .

 Privatization does not always means the competition. The explanation is as following figure.13.

When the demand -the quantity of elderly care need at the society - is less than the supply - the quantity of the elderly care resource -, suppliers must compete one another and the quality of the care would improve and the price would decrease.

But if the demand is much bigger than the supply, the suppliers do not need to compete one another and the quality does not improve . In this case, even if the private bodies cut down the quality in order to earn more money, the elderly people have to buy the service, because there are no alternative. If the demand is much bigger than the supply, the suppliers sometimes compete one another to cut down the cost to be more profitable.

This is why the quality of the private geriatric hospitals and the private nursing homes in Japan can not be improved, sometimes become worse and worse.

In Japan, the demand of the elderly care is much more than the supply, so the business catering elderly care has the big risk of the worse quality. But the private bodies are non-profit organization, the risk is not so big.  

In Japan, there are about 700,000 bedridden elderly. The biggest reason is that lack of the rehabilitation. To improve the efficiency and the quality of the care, continuity of the care and the integration among social service, care and medical treatment are necessary. But in Japan private service, voluntary service, public service and care by the family are provided quite independent I y . So even if the quantity of the care increased, the efficiency and the quality do not increase and the number of the bedridden elderly would not decrease.

For example, it is often the case in Japan, that the patient comes back home from the hospital, but he can not get home help service at home and become bedridden once again, and finally move back to the hospital once again. The problem is that there is no communication between the private hospitals and the public home help service.

The situation in Japan is similar to that in U.S.A.. U.S.A. has the private health care system, but the cost of health care per GNP is 13.4% in 1991 and is the most expensive in the world. Moreover about 30% of the poor people in U.S.A. can not get the health care. On the other hand, the health care cost in Sweden is 8.4% in 1991(Source: SPRI information nr3 1993).

This result shows that the privatization does not always lead to the efficiency. The continuity and the integration in the total system is very important about the elderly care. 

It is most needed in Japan that the public elderly care will be increased rapidly and have the main responsibility of the total elderly care and the public bodies will be the coordinator and have the close communication with the private service, voluntary service and family care-givers.

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