A Study of the System of Health and Medical Care for the Aged

日本の医療保障は,1961年,国民皆保険体制の発足で大きな前進をしめした。しかし,その体系は,高齢者の医療保障を軽視したものであった。高齢者の受療機会を保障するために地方公共団体からはじまった肩代わり制度は,1973年,老人医療費支給制度としてスタートした。老人医療費支給制度は,医療保険に「足つぎ」し,医療保険を優先させたものであった。この制度体系は,高齢者の健康保障を1歩前進させはしたが,多くの課題を当然のこととして生み出した。また,老人医療費支給制度は,公費負担医療の性格をめぐる議論を再現させもした。本論文は,老人医療費支給制度の制度体系に注目し,その特徴を,仕組み,医療保険優先,肩代わり負担,出来高払い方式,疾病の特定化,対象の拡大について検討した。さらに,公費負担医療の性格などについて検討をくわえ,老人医療費支給制度を新しい公費負担医療として位置づけた。Medical security in Japan significantly increased with the start of a system of health insurance for the whole nation in 1961. However, health care coverage for the aged was treated lightly in this system. Thus, local public bodies adopted a system taking over elderly patients' coverage. The government in 1973 started this system of provision for medical costs for the aged. The system of provision for medical costs for the aged was an addition to the system of health insurance and gave priority to medical care through medical insurance. Although the adoption of this system for the aged was certainly a great step for coverage, it also caused many problems. Additionally, it brought up a controversy over the role of medical care at public expense again. This study focused on the system of provision for medical costs for the aged and examined its structure, priority of health insurance, takeover of elderly patients' pay, payment at piece rate, specification of diseases, and extension of objects. Furthermore, it studied the role of medical care at public expense and highlighted the system as another system of new medical care at public expense