earticle

영어

The Japan`s long-term care insurance system was envisioned in Japan at the mid-1990s, and the frame of the system was formed led by the Ministry of Health and Welfare, the law was established in 1997. As a result of long-term care insurance, the quantity of service supply increased, the users were able to select services, the quality of services were improved by competition, and innovation was promoted and that the burden of family care has been reduced. On the other hand, an increase in fiscal burden and lack of care workforce is a major issue. Looking at long-term care insurance in Japan from the viewpoint of “quasi-market”, although issues remain in neutrality of care managers and in evaluating quality of services, conditions for success have been dealt with to some extent. In addition, if we look at the outcome of long-term care insurance with four evaluation criteria of efficiency, responsiveness, choice, equity, it seems to be improving in comparison with the previous system. Toward reform of the long-term care insurance system there is a conflicting argument between “the principle of market group” seeking more thorough market mechanism and “the regulation reinforcement group” for user protection. Assuming universalism, institutional design of “quasi-market” is required to promote innovation through competition, to improve quality and improve efficiency.

일본어

日本では1990年代半ばには、高齡者の介護を社會化するための公的な介護保險制度が構想され、厚生省主導で制度の骨格が形作られ1997年 に法律が成立した。介護保險の成果としては、サ一ビス供給量が增加し、利用者がサ一ビスを選擇できるようになったこと、競爭によって サ一ビスの質が向上、イノベ一ションが促進されたこと、家族による介護の負擔が輕減されたことが擧げられるが、財政負擔の增大と介護 勞動力の不足が大きな課題である。 日本の介護保險を「準市場」の視点からみると、ケアマネ一ジャ一の中立性や質の評價に課題が殘るものの、準市場成功の條件はある程度 對處されているといえる。また介護保險の成果を效率性、應答性、選擇性、公平性の４つの評價基準で見れば、以前の制度と比較して向上 している。介護保險制度の改革に向けて、より市場メカニズムの徹底を求める「市場主義派」と利用者保護のための「規制强化派」の議論 があるが、普遍主義を前提としつつ、競爭によってイノベ一ションを促進し、質の向上と效率化を圖る「準市場」の制度設計が求められる 。