[Changes in community health and welfare services with introduction of the long-term care insurance system in Japan].
OBJECTIVE
In Japan, a long-term care insurance system for elderly people was introduced in April, 2000. We have conducted a survey using a questionnaire in order to explore consequent changes in community health and welfare services.


METHODS
We sent questionnaires to all municipal governments (671 cities, 1,991 towns, 567 villages and 23 wards) in Japan in November, 2001, and obtained replies from 441 cities (response rate: 65.7%), 800 towns (40.2%), 197 villages (34.9%), and 16 wards (69.6%). The questionnaire included questions concerning the budget and manpower for community health and welfare services, the state of the long term care insurance system, and the activities of public health nurses.


RESULTS
A total of 57% of all municipal governments was found to be carrying out the long term care insurance program in collaboration with other governments. In order to clarify the changes in welfare services for elderly people from the budgetary viewpoint, we calculated the ratios of the 2000 and 2001 fiscal budgets applied for welfare services for elderly people, in comparison with the 1999 fiscal year. The budgets for elderly people declined to about 40% in 2000 and 2001 compared with 1999, since the budget for care services was transferred to the account of the long term care insurance system. The activities of public health nurses employed by municipal governments were not affected by the introduction of long term care insurance system. About 80% of all municipal governments suggested that both the amounts of care services received by each elderly people and the number of elderly people who received care services were increasing, and about 70% indicated that the quality of care services was improved with introduction of the long term care insurance system.


CONCLUSIONS
Most municipal governments consider that introduction of the long term care insurance system has had a good influence on community health and welfare services. Moreover, our results suggest that the long term care insurance has a beneficial impact on care services themselves.
Shirasaya
Koji
K
Faculty of Economics, Fukuoka University.
Shimada
Naoki
N
Nakahara
Toshitaka
T
Shiomi
Shigeki
S
Satomura
Kazunari
K
Takemura
Shinji
S
Kondo
Takefumi
T
D000368:Aged; D002017:Budgets; D003153:Community Health Services / Q000191:economics* / Q000639:trends; D006299:Health Services for the Aged / Q000191:economics; D006801:Humans; D007353:Insurance, Long-Term Care; D007564:Japan; D009313:National Health Programs; D012947:Social Work / Q000191:economics* / Q000639:trends; D011795:Surveys and Questionnaires