Later discussions of integrated care did not focus
exclusively on collaborations with medical professionals;
they also were intended to promote the coordination
of all social care resources available to support
continuity of the daily lives of seniors. In social services,
informal care is much more common than it is
in medical services. In order to contain the costs associated
with medical attention, the integration of informal
care became a significant element of the policy agenda
in the promotion of community-based integrated care.
With an ageing population, however, the greater part
of long-term care insurance benefits is gradually shifting
towards more intense care services. From now
on, social care will be increasingly redefined as an
important resource but something that is secured ‘outside’
long-term care insurance services. For that reason,
the pressures placed upon the mutual aid
facilities of communities will also continue to be on
the rise. Unfortunately, we cannot say that effective
methods for coping with these pressures have been
established.
Long-term care insurance system adopted the ‘quasimarket
mechanism’ as its service model. Under the
quasi-market mechanism, profit-seeking providers
have increased the risk of superfluous services. Municipalities
were required to take measures to solve this
risk such as replacing private providers with community
general support centers in the role of care management
and requiring insurers to develop long-term care insurance
plans based on needs surveys. The Community
Care Council has been introduced to share the community-
based care mission with providers. Such efforts
may counteract the threats associated with commercialization,
though this remains to be seen.
Attempts to integrate community-based care and longterm
care require coordination with the medical care
system. Municipalities must now manage the Community
Care Council, construct a providers’ network and
include medical care providers within that system.
The care integration within the medical system, however,
includes coordination between clinics located
in a municipality and hospitals providing care for a
wider territory. Casework, therefore, often must cover
a wider geographic range and is not confined to the
municipality. In this respect, the attempt to include medical
care into the integrated care network is at odds with