Community Medicine and Terminal Care－Public Nursing Care Insurance and Community

The low birthrate and aged society problem has appeared from the 1970s. As a geriatric hospital problem, its solution was pushed against medical treatment, and elderly people's welfare "became [ historically, / put it to sleep ]" a problem as an old-man problem. In rapid progress of an aged society, the correspondence to a low birthrate and aged society was decided upon an "Angel Plan" and "Gold Plan" from the second half of the 1980s. It could not catch up with the speed, and reexamination started immediately, the direction of correspondence by social insurance became clear at the second half of the 90s, and "public nursing care insurance" was established. However, since this system was established considering the "bedridden elderly" as an object model, it aimed at the direction of "home care." And conquest of "confusion of medical treatment and welfare" had taken the direction which converts a responsibility subject into "welfare" for the old man of a terminal state from medical treatment with "Takenaka and the Hiroi report." However, it was based on actual recognition that increase of the medical expenses to the old man of a terminal state will collapse a universal national health insurance system from now on, from a financial viewpoint. Ishii and Yokouchi and others performed criticism to this, and the dispute "deemed terminal (cure care)" arose. It was shown that the actual recognition shown in the report poses a problem, and elderly people's increase does not turn into increase of medical expenses. Rather, this "elderly people's increase" is strongly connected with collapse of the area fundamentally based on the measure of "overconcentration to Tokyo" since the 60s instead of a health professional's responsibility, and the problem of a decrease in the birthrate, and conversion of the radical policy is called for. The responsibility of a country is large. "Reexamination of public nursing care insurance" at which it aims now set the object model to the dementia patient, made "home care" and "habitation care" coexist, and has taken the direction where the "area" supports it. Is this possible in the weakened local self-governing body like Japan or not? It will be required to convert the state of Japan itself radically rather.journal articl