Research on the Establishment of a Long-Term Care System for the Elderly with Alzheimer’s Disease Under the Background of Long-Term Care Insurance: A Literature Review

With the aging of the country’s population structure,the problem of social pensions is becoming more and more serious.As for the issue of social pension,the elderly with Alzheimer’s disease are a special group,and the issue of care services for these elderly has attracted widespread attention from society.However,judging from the current level of social security provided to the elderly with dementia in the country,there is a serious imbalance between supply and demand.Therefore,this problem needs to be solved urgently and is of great significance for further improving the country’s social pension security system.Routine care is limited to hospitals and mainly focuses on the patient’s condition.Patients fail to receive comprehensive care services and the effect is not ideal.Therefore,in order to improve patients’cognitive function and quality of life,and learn from international experience,a“community-institution-home”three-dimensional linkage care model based on long-term care insurance can be established.The application of this model can effectively solve and further improve the country’s elderly care and social security system.

Performance of Rural Municipalities After the 2015 Reformation of Long-Term Care Insurance in Japan

Worldwide,welfare is trending from a welfare state model to social participation to ensure the sustainability of health care systems.Japan,where the aging rate will reach 40%by 2060,reformed public Long-Term Care Insurance(LTCI)on a large scale in 2015 and started the Comprehensive Service project(CS project),which emphasizes the prevention of long-term care through social participation in the community.Through this project,communities work to develop prevention efforts revolving around the community salon/caféand mutual support,including all daily tasks that previously were the purview of family members.Each municipality has an obligation to promote a CS project through new community development initiatives among community members.The purpose of this study is to investigate the CS projects performed by rural municipalities and to explore the important factors for their success.The authors used a case study methodology and constant comprehensive methodology for analyzing interview data to pull out the elements of successful initiatives.The study shows that the following factors influence success:recognition of demographic risk,recognition of the ineffectiveness of LTCI services,developing a passionate philosophy and strategy as a municipality,developing community members’initiative,and having many assets and full participation in the community.These factors imply that community development is a critical part of any successful CS project.

Influence Factors of Mobility-Related Activities of Daily Living in Chronic Dialysis Patients Needing Long-Term Care: Analysis of Long-Term Care Eligibility Assessment Survey Data

Background: In the near future in Japan, chronic dialysis patients will likely face a situation where the aging and the lengthening of hemodialysis treatment periods will adversely affect the mobility-related activities of daily living (MR-ADL). The aim of this study was to investigate chronological change in MR-ADL among chronic dialysis patients in need of long-term care and the effect of admission to long-term care facilities on their MR-ADL. Methods: Data were analyzed from a long-term care eligibility assessment survey conducted in late March 2009 of 1000 individuals residing in Niigata City, Japan who were approved to receive long-term care. Then data from those individuals who had undergone the assessment survey ≥4 times over a period of ≥4 years were statistically evaluated. To reveal change in MR-ADL, this study performed a three-way analysis of variance with mean survey scores from assessment categories 2 - 5 containing questions related to MR-ADL as the independent variable and the number of eligibility assessment surveys (within-subjects factor), facility admission, and dialysis therapy (between-subjects factors) as dependent variables. Results: We observed the effect of facility admission in individuals aged >70 years for categories 2 - 5, and observed the effect of the number of assessment surveys taken only in women ≥80 years for categories 2 and 5. Regarding the effect of dialysis therapy, female dialysis patients aged ≥80 years and in need of long-term care scored significantly higher on survey items for transferring, grooming, toileting, eating, and instrumental activities of daily living, all of which are indicators of a moderate decline in ADL. Conclusions: Because dialysis is often initiated in women aged around 80 years, ADL in this group of individuals can be improved by the initiation and proper provision of dialysis.

Healthcare Needs of the Elderly People over 85 Years Living Alone on the Island Area in Japan: A Descriptive Study

Background: Japan has the highest aging people accounting 33.8 million with the rate of 26.7% in 2015. Although, public long-term care insurance services support people age 40 years and above, most of the users are 85 years and over due to their more vulnerability for getting sick. This study describes the physical, mental and social status of the elderly people aged 85 years and over, who were living alone at home. Method: A cross-sectional study was conducted between November 2016 and March 2017 in the island of Kure city, Hiroshima, Japan. A structured questionnaire and scales were used for data collection and documentation of physical measurements. Descriptive analysis was used. Result: A total of 190 subjects were participated, and the data were analyzed. The age range of the subjects was 85 to 98 years, and 68.4% of them were 85 to 89 years old. Male and female ratio was 21.6% vs 78.4%. Subjects of 17.4% continued their occupation at the time of the study period and most of them involved in agricultural work (93.9%). A certain percentage of the subjects had abnormal physical, mental and social difficulties and need additional support from family, friends, relatives, and community. Conclusion: Early detection and intervention such as disease management, nutritional support, and human support are required. The findings suggested policy makers to predict the burden and provide necessary care for these elderly people. It is necessary to aware family, friends, relatives, community and government supporting staff to provide information on correct recognition and usages of long-term care insurance services for these elder people.

当代中国农村医疗体制的变革与发展趋向

当代中国农村医疗体制在六十年中经历了翻天覆地的变化。在1978年之前,中国农村的医疗服务体系由县、乡、村三级组成,县级医疗机构属于全民所有制的事业单位,乡村医疗机构属于人民公社集体所有,它们在农村医疗服务方面发挥了积极作用。改革开放以后,传统的合作医疗被新型合作医疗所取代,即嵌合在集体主义政治经济制度中的社区微型医疗保险被政府补贴的自愿性公立医疗保险所取代。依然处在行政化制度和组织中的农村各级公立医疗机构都走上了商业化道路,但民营医疗机构在农村的发展还很不充分。由于医疗保障体系还欠发展,医保机构第三方支付对于医疗机构还缺乏制约,农村公立医疗机构的医药费用上涨幅度超过了农村居民收入的上涨幅度。针对这些问题,新一轮医疗卫生体制改革为农村医疗卫生事业的发展带来了机遇。新农合的巩固、公共财政投入向农村地区的倾斜、社会资本的进入、公立医院的法人化有助于农村医疗事业的发展,但公立医疗机构的行政化则有可能对县医院和乡镇卫生院的发展前景投下了阴影。

长三角生态绿色一体化发展示范区医疗保险基金监管异地联审互查实践

随着长三角生态绿色一体化发展示范区(以下简称“示范区”)医疗保障一体化进程的加快,门诊免备案、经办服务统一、结算项目范围扩大及“互联网+医疗”模式的拓展,异地就医费用的监管压力增大。为形成有力、有效且可推广的异地就医医疗保险(以下简称“医保”)基金监管政策,通过文献研究明确异地就医医保监管的概念内涵和必要性,结合实地调研和示范区三地医疗保障部门的管理者、执行者及医疗保障领域专家学者等的深入访谈,对示范区试行的医保基金异地联审互查办法进行回顾性研究。该办法是在三地医疗保障政策及审核机制尚未统一的背景下,借助三地地理位置优势实现对异地就医费用全流程有效监管的最优选择。目前机制运行良好,具有一定可行性,但在智能化监管方式上和可推广性方面需要进一步优化。

昆明市分级诊疗制度实施现状及问题研究——基于四家社区卫生服务中心的调查

构建合理的医疗服务体系,实现医疗卫生资源的优化配置,已成为健康中国战略的主要任务。推动分级诊疗是重塑医疗卫生服务体系的重要环节。笔者对昆明市四家社区卫生服务中心进行了调研,从人、财、药的配置、医疗保险政策的调控、基层医院在双向转诊中面临的问题对工作人员进行访谈,通过问卷调查了解老年人的就医选择,以此分析昆明市分级诊疗制度实施中存在的共性问题,结合全国试行分级诊疗地区的经验做法,提出促进分级诊疗的对策建议为做好分级诊疗的顶层设计和部门协调、持续提升基层医疗卫生服务能力、充分发挥医疗保险制度的杠杆作用。

Correlations between Motor Ability with Gait Speed and Cognitive Functions in Rehabilitation Users

Purpose: To compare and examine motor and cognitive functions in people who require support, and in healthy elders. Method: The variables of age, BMI, educational background, blood pressure, grip strength, knee extension, gait speed, MMSE, and subjective health feeling for 36 rehabilitation users and 22 healthy elders were assessed. We compared and examined motor and cognitive functions in rehabilitation users who need support and healthy elders. Results: The percentage of MMSE scores with 27 points or higher and that of subjective health feeling with 3 points or higher were significantly higher in healthy elders than in rehabilitation users. Systolic and diastolic blood pressure were significantly higher in rehabilitation users than in healthy elders. Gait speed and MMSE scores were significantly higher in healthy elders than rehabilitation users. Conclusion: Gait speed could be used for physical fitness in elders. Gait speed was the best physical fitness measurement for elders. Gait speed of rehabilitation users was strongly related to MMSE scores. Gait speed could be a determinant of MMSE scores.

跨代连结型长期护理保险最优决策研究

随着我国人口老龄化的不断深化,老龄人口及失能人口的赡养成为亟待解决的经济社会问题。本文基于以家庭为单元的保障模式的理念,以陪护者和年长者连结投保型长期护理保险为切入点,建立了一个包含储蓄、消费、家庭护理、护理保险保额等决策变量的两阶段最优决策模型,考虑陪护者和年长者同时决策和先后决策两种决策方式,并从双方效用最大化的角度出发,得到了二者的最佳投保和护理决策。最后基于中国健康与养老追踪调查数据,测算得到了模型的实证解,并研究保费费率和风险规避程度对决策结果的影响。实证分析结果显示,结合实际数据计算出的最优决策变量具有客观性和可行性,本文考虑的连结投保式创新型长期护理保险能够促使投保人做出理性决策,促进长期护理风险的保障和长期护理保险的发展。