Main Article Content
Aging is a global issue not especially in the developed world. Governments of both developed and developing countries struggle with the financial burdens of aging populations. The Japanese government is implementing the Community-based Integrated Care System (CbICS) for elderly individuals to provide comprehensive up-to-end-of-life support services in communities. This system proposes four elements: self-help (Ji-jo), mutual aid (Go-jo), social solidarity care (Kyo-jo), and government care (Ko-jo); self-help and mutual aid are expected to be strengthened for successful policy implementation. Thailand, with the highest aging rate in Southeast Asia, has a successful system based on primary health care (PHC). The authors discussed ideas from the Thai health policy for the elderly to address the challenges in the Japanese system. For a data collection method, the authors conducted document reviews. Interviews with officers from the relevant ministries were conducted to verify the evidence to strengthen self-help and mutual aid in Japan’s CbICS. Factors promoting the implementation of the Thai health policy for the elderly were extracted. Aging issues were influenced by the national strategy. The second National Plan for Older Persons focused on community-based care services following the PHC concept and tried to implement them comprehensively along with the ministries.
The factors promoting the implementation of the Thai health policy for the elderly included “Clear and adequate government role distribution”, “Decentralization and authority of local governments”, “Earlier preparation”, “Empowerment and encouragement of preventive activities in the community”, “Evaluation system”, “Evidence-based”, “Fit for global concepts and national issues”, “Involvement of stakeholders”, and “Solutions to fragmentation”.
The results indicated that the Thai health policy for the elderly was characterized by a strong central government, with emphasis on well-being and the prevention of diseases, and involvement of multiple ministries. Japan’s CbICS could provide more effective services when community activities adopt Thailand’s community-based elderly care. Relevant ministries should be more integrated for better service provision, and Japan’s PHC concept should be reconsidered for application to its peculiar situation.
2. Okamoto Y. Health care for the elderly in Japan: medicine and welfare in an aging society facing a crisis in long term care. BMJ. 1992; 305:403-405.
3. OECD. A Good Life in Old Age? Monitoring and Improving Quality in Long-term Care. OECD Health Policy Studies. 2013.
4. Statistics Bureau, Japanese Ministry of Internal affairs and Communications. 1960 Population census. Portal Site of Official Statistics of Japan website. https://www.e-stat.go.jp/ (accessed December 15, 2018).
5. Ministry of Health, Labour, and Welfare, Japan. Overview of Medical Service Regime in Japan. https://www.mhlw.go.jp/bunya/iryouhoken/iryouhoken01/dl/01_eng.pdf (accessed December 15, 2018).
6. Ministry of Health, Labour, and Welfare, Japan. Outline of the revision of the Long-Term Care Insurance System, etc. to strengthen the Community-based Integrated Care System in 2017-18. https://www.mhlw.go.jp/english/policy/care-welfare/care-welfare-elderly/dl/ltcis_2017_e.pdf (accessed December 15, 2018).
7. Anderson GF, Hussey PS. Population aging: a comparison among industrialized countries. Health Aff (Millwood). 2000; 19:191-203.
8. Mitsubishi UFJ Research and Consulting Co., Ltd. Chiiki-hokatsu-kea-shisutemu to chiiki manejimento. 2016. https://www.murc.jp/uploads/2016/05/koukai_160509_c1.pdf (accessed December 15, 2018). (in Japanese).
9. Sudo K, Kobayashi J, Noda S, Fukuda Y, Takahashi K. Japan’s healthcare policy for the elderly through the concepts of self-help (Ji-jo), mutual aid (Go-jo), social solidarity care (Kyo-jo), and governmental care (Ko-jo). BioScience Trends. 2018; 12(1): 7-11. DOI: 10.5582/bst.2017.01271
10. Campbell JC, Ikegami N. Long term care insurance comes to Japan. Health Aff (Millwood). 2000; 19: 26-39.
11. National Institute of Population and Social Security Research. Financial Statistics of Social Security in Japan 2016. https://www.ipss.go.jp/ss-cost/j/fsss-h28/H28.pdf (accessed December 15, 2018). (in Japanese)
12. Rechel B, Grundy E, Robine JM, Cylus J, Mackenbach JP, Knai C, McKee M. Ageing in the European Union. Lancet. 2013; 381:1312-1322.
13. Panagioti M, Richardson G, Small1 N, Murray E, Rogers A, Kennedy A, Newman S, Bower P. Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis. BMC Health Serv Res. 2014; 14:356.
14. Goetzel RZ, Shechter D, Ozminkowski RJ, Stapleton DC, Lapin PJ, McGinnis JM, Gordon CR, Breslow L. Can health promotion programs save Medicare money? Clin Interv Aging. 2007; 2:117-122.
15. Kabayama M, Watanabe C, Ryuno H, Kamide K. Positive and negative associations of individual social capital factors with health among community-dwelling older people. Geriatrics & gerontology international. 2017; 17:2427-2434.
16. Honjo K, Tani Y, Saito M, Sasaki Y, Kondo K, Kawachi I, Kondo N. Living Alone or With Others and Depressive Symptoms, and Effect Modification by Residential Social Cohesion Among Older Adults in Japan: The JAGES Longitudinal Study. J Epidemiol. 2018; 28:315-322.
17. Saito M, Kondo N, Aida J, Kawachi I, Koyama S, Ojima T, Kondo K. Development of an instrument for community-level health related social capital among Japanese older people: The JAGES Project. J Epidemiol. 2017; 27:221-227.
18. United Nations. Probabilistic projection of population age 60+ (both sexes combined) by region, subregion, country or area, 2015-2100 (thousands). World Population Prospects: The 2017 Revision. 2017.
19. World Health Organization. The World Health Report 2008 - Primary Health Care (Now More Than Ever). https://apps.who.int/medicinedocs/documents/s22232en/s22232en.pdf (accessed December 15, 2018).
20. Noda S, Kobayashi J, Koji W. A study on health care and health promotion policies in ageing society for heath sector reform in Japan and Asian countries. The Grant for National Center for Global Health and Medicine Report (Subject No. 28-7). https://www.ncgm.go.jp/100/010/030/report_2017/28-7.pdf (accessed December 15, 2018). (in Japanese)
21. The National Commission on the Elderly, the ministry of Social Development and Human Security Thailand. The Second National Plan for Older Person (2002-2021) revised of 2009. 2010.
22. United States Agency for International Development. Taking the plus policy: The Policy Implementation Assessment Tool. https://www.healthpolicyplus.com/archive/ns/pubs/hpi/1155_1_PIAT_Paper_Taking_the_Pulse_of_Policy_acc.pdf (accessed December 15, 2018).
23. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3:77-101.
24. VERBI Software GmbH. MAXQDA Ver.12. https://www.maxqda.com/ (accessd December 15, 2018).
25. Jitapunkul S, Wivatvanit, S. National Policies and Programs for the Aging Population in Thailand. Ageing International. 2008; 33:62-74.
26. Suwanrada W. National experiences from Thailand regarding long-term care of older persons. ESCAP, Bangkok, 2014. https://www.unescapsdd.org/files/documents/Item%203%20%28b%29%20Long-term%20care%20in%20Thailand.pdf (accessed December 15, 2018).