seniors, the demands on long-term care were bound to
grow significantly in the near future. For cases where
users needed both long-term care and medical care,
a system was proposed whereby the users could live
at home for as long as possible and the length of any
hospital stay would be minimized. Various suggestions
were considered, including the instigation of a 24-hour
system of home-based care with coordinated medical
care that would be capable of dealing with a range of
medical situations from chronic ailments to advanced
acute illnesses.
Also on the agenda was the systemization of diverse
social resources for care. In order to make it possible
for elderly persons to continue to live in the community,
it was necessary not only to enhance coordination
between the services covered by medical insurance
and long-term care insurance but also to put in place
various forms of daily support. Mobilizing social
resources would provide comprehensive support,
including medical treatments, long-term care, health
services, daily life support and housing. To contain
costs, priority was given to those requiring intense
long-term care. Those requiring light social care would
be placed outside the scope of insurance beneficiaries
and their services handled ‘outside’ long-term care
insurance. Instead, they would rely on community
mutual aid resources.
Integrated care was, therefore, something that required
coordination not only of different formal services of publicly
financed systems but also of the various resources
in the community. Concrete measures to promote integrated
care included the establishment of community
general support centres and the assumption of management
functions on the part of the local government.
In response to this policy agenda, long-term care insurance
system was reformed in 2011, leading to the new
services and the local administration strategy implemented
in 2012 [20].