Nursing services under the knife

The health and welfare ministry plans to end some services under the nursing care insurance system for people whose conditions are not so severe, and have municipalities take over those services from fiscal 2015.

Since the cost of the insurance system is swelling as the nation’s population grays, it may be necessary to prioritize services. But the government should take utmost care so that services for people who truly need them will not be terminated. At the same time, municipalities should make various efforts to improve the lives of elderly people once they take over nursing care services.

Currently the total cost of the nursing care insurance system is about ¥9.4 trillion annually. But it is expected to increase to about ¥21 trillion in fiscal 2025 when every postwar baby boomer is at least 75 years old. If the trend continues, the average monthly premium paid by people aged 65 or older will rise from about ¥5,000 to about ¥8,200.

People certified to receive nursing care services under the insurance system are classified into one of seven categories in ascending order from the least to the greatest need of care.

The health and welfare ministry at first planned to eliminate all care services for people in the lowest two categories and shift the responsibility for them to municipalities. But after facing criticism and opposition, the ministry has decided to transfer only home-visit services by attendants and services for outpatients at day care centers to municipalities.

Other services such as home visits by nurses, short-term hospitalization at day care centers and loans of welfare equipment will continue to be given in a uniform way throughout the nation.

In fiscal 2012, home-visit services by attendants and services for outpatients at day care centers cost about ¥280 billion, accounting for about 60 percent of the cost of the preventive care services given to people in the lowest two categories.

Even if these services are taken over by municipalities, their costs will be paid out of the nursing care insurance system in principle. But the government has a goal of reducing the annual increase rate of these costs to 3 to 4 percent, the same as the annual population growth rate for people aged 75 and up.

Although the ministry says it will be flexible, it is possible that some municipalities will face funding shortages and be forced to lower the quality of the services. This could worsen the health of recipients of the services and eventually lead to greater fiscal pressure on the insurance system. The ministry should think carefully about this potential danger.

On the other hand, municipalities should try to improve the services by mobilizing volunteers and making an effort to recruit workers at employment service centers for older people. The activities of such people can inject new energy into graying communities, although the quality of services will likely vary from municipality to municipality depending on financial conditions.

The central government should help municipalities that are financially weak and short on human resources so that the quality of services is maintained at similar levels across the nation.