7.5 |
The Future of the Elderly Care by the Private Body In Japan |
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 organization- 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.
(1)
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Only the wealthy elderly can afford the business catering retirement
homes and nursing homes, because they are too
expensive . |
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 in U.S.A. middle-class elderly can stay at the
private facilities.
The first reason is that the price is 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 for the private
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 .
(2)
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The quality of the care does not improve by the privatization,
when the demand of the care is too bigger than the supply.
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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.
(3) |
If the care by the public service and private service are provided
independently without continuity and integration, they are very
ineffective. |
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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