Japan's referral insurance system

發布時間:2020-06-03 02:12

下面為大家整理一篇優秀的essay代寫范文- Japan's referral insurance system,供大家參考學習,這篇論文討論了日本的介護保險制度。日本自20世紀70年代進入老齡化社會以來,就在不斷探尋養老模式,并提出了介護保險制度,有效緩解了財政壓力,解決了照顧老年人的難題,促進了就業及相關產業的發展。日本的介護保險制度一方面在減輕家庭負擔、提高老年人生活質量、降低政府財政壓力等方面取得了良好的效果,另一方面對促進就業、拉動介護相關產業發展等方面也起到了積極的推動作用。

Since Japan entered into an aging society in the 1970s, it has been constantly exploring the pension model and put forward the intermediary insurance system, which has effectively alleviated the financial pressure, solved the problem of caring for the elderly, and promoted the development of employment and related industries. On the one hand, Japan's intermediary insurance system has achieved good results in reducing the family burden, improving the quality of life of the elderly and reducing the financial pressure of the government. On the other hand, it has also played a positive role in promoting employment and promoting the development of the intermediary insurance industry. The successful experience of Japan has certain reference significance for China, a country with an aging population.

Japan's aging population has grown rapidly since it entered an aging society in the 1970s. In 2010, 17.3 percent of Japan's population was over 65 years old. By 2016, the proportion had grown to 27.3 percent, and it is expected to exceed 30 percent by 2025. In order to deal with the health and safety problems brought by the aging population, the Japanese government has introduced a series of policies. For example, the law on the well-being of the elderly promulgated in 1963 provides for the establishment of nursing homes and free housing for low-income elderly; The policy of free medical care for the elderly was implemented in 1973. In 1982, the policy of free medical treatment was abolished, and the health care law for the elderly promulgated stipulated the out-of-pocket proportion of medical treatment for the elderly, requiring hospitals to provide integrated services of medical treatment and nursing, with the expenses borne by medical insurance. In 1989, the 10-year plan for promoting the welfare of elderly people's insurance was promulgated, which proposed to further improve the construction of old-age infrastructure and promote the development of home-based old-age care service. These policies have played a positive role in stabilizing the society and improving the living environment of the elderly, but objectively increased the government's public expenditure. Especially since the implementation of free medical care for the elderly, hospitalized elderly surge. In the period of rapid economic development, finance can still meet the demand for medical insurance. However, since the bursting of the economic bubble in the 1990s, Japan's economy has changed from high growth to low growth and negative growth. Under the background of sustained economic downturn, the financial resources of medical insurance in Japan appear "hollowing out". In this context, Japan carried out the structural reform of the medical security system in the late 1990s, and the mesophil insurance system came into being in this context.

The word "meshika" first appeared in Japan's welfare law for the elderly enacted in 1963. "meshika" means to take care of and take care of the elderly. Nursing and nursing are originally two words of the same origin, but with the development of medical career, the two gradually have a distinction, nursing more tend to follow the doctor's advice for professional medical treatment, nursing more tend to the sick and functional disorders of the elderly for a long time, daily life care and care. Mediation pays more attention to give play to the existing living ability of the elderly, does not take over, and stimulates their willingness to live. Since the implementation of the policy of free medical care for the elderly in the 1970s, the phenomenon of "social hospitalization" has been caused. The elderly have occupied hospital beds for a long time due to neglect after discharge, and the high hospitalization costs have increased the financial pressure of the government. In order to deal with this new social problem, the Japanese government issued the health care law for the elderly in 1982, which separated the referral service from the medical service and established the referral recuperative medical institutions. In 1997, the introduction of the introduction of the insurance system. As a compulsory insurance system, intermediary insurance, annuity insurance, medical insurance, employment insurance and labor insurance constitute the social insurance system of Japan.

The system requires people over the age of 40 to be covered. Insured people are divided into two groups according to age: those over 65 and those between 40 and 64. The first class insurant produces any need to introduce the circumstance that protects to give insurance to pay, the second class insurant must have the disease that formulates and aging-related and need to take care of when just gives insurance to pay.

Insurance by each city, district, town, village government holds a position, basically be responsible for collecting insurance cost, accept insurance application, the type that affirmatory medium protects a service to wait. The main function of the central and prefectural governments is to assist the urban and municipal governments in performing their functions and to provide financial support.

The intermediary insurance source is made up of three parts, of which 10% is borne by the users, and the remaining 90% is half by tax and half by insurance premium. The central government, the prefectural government and the urban and township governments bear 25%, 12.5% and 12.5% of the tax, respectively. In 2005 the Japanese government adjusted the interface protection system, the central government to undertake the part of 20% and 5% were divided into two parts, 5% is to adjust delivery of gold, used to implement the degree of population ageing heavier region and aging degree is lighter burden balance between cost, as well as the poor areas and rich areas between the balance of the local government financial burden. From the rest of the premium income, among them, the first kind of insured burden by 17%, the second category of insured 33% burden, the burden proportion adjustment once every three years, with the aging of the population, the proportion of the second category of insurant decline gradually, so the proportion of the burden of the second category of insurant is also in gradually reduce, in April 2015 to April 2018, the burden of adjustment for the first kind of insurant 22%, the second category of insurant pay 28%.

Japan's intermediary insurance system is not an overnight success, is in response to the constantly emerging social problems on the basis of repeatedly revised. Since its promulgation and implementation in 2000, it has undergone five revisions by the end of 2018, averaging one revision every three years. In 2005, the referral insurance system was revised for the first time, with the addition of preventive referral services and appropriate subsidies for low-income elderly persons admitted to referral institutions; In 2008, it was revised for the second time to improve the treatment of referrals and reformulate the evaluation standards of referrals. In 2011, the third revision added 24-hour mesonursing service, promoted community mesonursing service, and established a small-scale composite service institution. In 2014, the fourth amendment reduced the amount of premium paid by low-income people in the first category of insured, and raised the co-pay ratio of high-income people from 10% to 20%. The fifth revision in 2017 further promoted the development of community mediation services, raised the co-payment ratio of high-income people to 30%, and adjusted the limit of co-payment of insured people from 37,200 yen to 44,400 yen per month. Based on the changes of Japan's relevant pension policies and the contents of these revisions, it is not difficult to see that the general trend of the pension model is mainly to expand welfare before the 1990s, and after that, especially in the 21st century, it shows the characteristics of reducing welfare. In addition, in the process of premium payment and payment, fully consider the income of the insured, the difference between the rich and the poor in various regions and the proportion of the elderly population, pay attention to the fairness of the system in the distribution.

At present most of the countries all over the world to establish the endowment insurance system, medical insurance system, but these systems are more inclined to give the old economy on the life to help or alleviate the pressure when sick in hospital, facing the arrival of the era of aging and disability, whether for referral to protect insurance should be spun off as an independent coverage has been controversial.

From the perspective of the development process of the Japanese medical insurance system, it is inevitable that the intermediary insurance will develop into an independent insurance because of the soaring medical cost, financial crisis and "social hospitalization". Secondly, from the perspective of the service object, there are essential differences between medical insurance and referral insurance. The former is targeted at patients suffering from diseases and pays the expenses incurred in the course of medical treatment; the latter is targeted at incapacitated and semi-incapacitated personnel and pays the expenses incurred when they enjoy the mediation service.

Japan's social security system was conceived in the 1960s and 1970s. With the rapid economic development, Japan built a welfare state model. As a part of the medical service, mesonursing service was positioned as a social welfare service, provided by government welfare agencies. On the one hand, this has increased financial difficulties, on the other hand, it has also led to the abuse of nursing services. To this end, the government has relaxed the access system, introduced the market mechanism, encouraged the participation of private capital and human resources in the field of intermediary care, and established a diversified business pattern including profit-making and non-profit organizations. The move of the Japanese government alleviates the financial pressure to some extent, and also enriches the content and types of nursing services.

Intermediate care insurance system since 2000 have been 18 years, in the protection of the elderly life quality, reduce the burden of the family has played a positive role, but in the context of population aging speed up development, per capita insurance premium from the beginning of the implementation of 2911 yen rose to 2017 per month per person per month, 5514 yen, is expected to reach 6771 yen per month in 2020, the cost, will reach 8165 yen per month in 2025. Total insurance premiums have also nearly tripled from 3.6 trillion yen in 2000 to 10.4 trillion yen in 2017. With the increase of the cost of intermediary care, it becomes an important issue for the sustainable development of intermediary care insurance system to reasonably arrange the payment of insurance premium and balance the payment proportion of each burden subject. In recent years, the Japanese government has also tried to redefine the recipients of benefits, increase the amount of personal burden, and increase consumption tax. First, from the perspective of the proportion of expenses borne by the insured, it was stipulated in the initial formulation of the mesotherapy insurance system that when using mesotherapy services, no matter how much income, the out-of-pocket proportion was 10%. In the revision in 2014 and 2017, it was re-stipulated that the out-of-pocket ratio of insured people who meet certain income standards was 20%-30%. Secondly, in terms of insurance premium payment, the Japanese government is discussing the introduction of immovable property. If the payment amount obtained by the insured exceeds a certain amount, the excess part can be collected from the inheritance tax paid when the insured inherits the property from his children after his death.

Nursing service is a labor-intensive industry, which has a great demand for professionals such as therapists, hygienists, therapists and nurses. With the rise of the intermediary nursing service industry, the number of practitioners of the intermediary nursing service increased from 549,000 at the beginning of the implementation of the system to 1.831 million in heisei 27, an increase of 2.3 times in 15 years. With the development of nursing services, the demand for nursing talents in Japan is also increasing. According to statistics, the demand for nursing talents in Japan will reach 5.3 million by 2025. For this reason, Japan has established a number of professional universities, including Nippon medical center, Tokyo fuku university, etc., to train nursing professionals, and some comprehensive universities, such as musashi university, have also set up the major of nursing. In addition, the government has set up a qualification examination for referrals for nursing professionals, formulated relevant laws and regulations, including the law on the well-being of the elderly, the law on social welfare and the law on referrals for nursing professionals, to ensure the improvement of the quality of referrals and the professionalization of referrals.

But compared with other industries, the interface protection work due to labor intensity, low wages, caused by informal staff ratio is low, workers, older, high turnover phenomenon, makes great gap medium armor industry practitioners in recent years, medium armor talent gap in 2015 and 40000, by 2025 the gap is expected to expand to 430000 people, currently 66% of referral agencies are understaffed. Although the government has taken some measures to improve the treatment of employees, improve the working environment of employees, and recruit foreign nurses, no significant effect has been achieved. The shortage of talent reserve has become a major obstacle to the sustainable development of the intermediary insurance system.

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