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政策提言

2017/07/15 

東京で開催した日・ASEAN保健大臣会合のラウンドテーブル2「地域コミュニティにおける統合ケアの推進」にてスピーチを行いました。(英語)

ASEAN-Japan Health Ministers' Meeting:
Universal Health Coverage (UHC) and Population Ageing
Roundtable Discussion 2 Promoting Integrated Care in Communities
by the Minister of Health, Labour and Welfare, Japan
Yasuhisa Shiozaki
 
Honorable Ministers, distinguished guests, ladies and gentlemen, please allow me to share my humble views on promoting integrated care in communities which I believe to be quite essential in an ageing society.
 
Firstly, I would like to emphasize the importance of community-based approach. Traditionally, health promotion service has been provided by doctors and nurses in community. This includes vaccination and parasite screening programs at school settings, maternal and child health check-ups, and screening and treatment of NCDs in community and workplace. These efforts led to a remarkable reduction in mortality. While efforts in disease prevention and control yielded great results, care for the elderly was left behind at home and family members were inevitably made responsible, with little to none public services available.

Further ageing and shrinking household size made it even more difficult for families to continue care provision at home-setting. As a result, long hospitalization of the elderly for non-medical reasons emerged as a social issue in late 1980s. This led to an introduction of public insurance system for long-term care in 2000.
 
Service provision dramatically increased under the new scheme. However, it soon became evident that the elderly, who were still capable of staying at home or in communities, were found to be overly dependent upon institutional services. Moreover, community services were not closely linked with medical care under the new scheme. For this reason, we are now trying to integrate medical care and long-term care into the community-based care and strike the best balance between the home-based and institutional care. Considering our lessons learnt, countries in earlier stage of population ageing may wish to target community-based elderly care from the outset that integrates medical and long-term care and home-based and institutional care.

Second is the speed of ageing. ASEAN member states that are to face population ageing will follow the same path as Japan sooner or later. It took 25 years for Japan to double the ageing rate from 7% to 14% and many ASEAN countries will experience similar or even more rapid ageing of society. We finally initiated a preparation process for introducing the long-term care insurance after the ageing rate exceeded 14%. Consequently, sufficient time for preparing human resources with appropriate skills for long-term care was not available. In addition, this new insurance scheme was introduced during a time of economic stagnation, which made it even more difficult to secure sufficient resources. Therefore, I would like to recommend my fellow Ministers to take on establishing community-based elderly care system before the ageing rate reaches two digits while ever strengthening robust economic growth.

Last but not least, I would like to highlight the importance of evidence-based care and prevention. Keeping the people active and healthy, thereby reducing the number of people in need of care, is critically important. Nutritional care, oral care, and rehabilitation training will potentially lead to improved physical and cognitive status of the elderly. On the other hand, excessive provision of care for daily life can potentially undermine the independence of the elderly. Accumulating scientific evidence on good community care which enhances self-reliance of the elderly and disseminating evidence-based practice nationwide are vital part of improving quality of service and safeguarding dignity of the elderly. We are now working to build a new data platform to scientifically analyze long-term care data which will start full operation in 2020, and we are more than happy to share with you our results in the near future.

In conclusion, the very fact that Japan is still struggling to achieve better integrated care system in the community may serve as a useful reference for ASEAN member states. I sincerely hope the ASEAN-Japan UHC initiative, which I referred to you earlier, would contribute to our common goal to achieve sustainable UHC which addresses the very challenges arising from population ageing.
 
Thank you.