The Health Status of Elderly People and the New Direction of Health Services

The projected increase of people in Japan aged 75 years and older in the years to come implies the increase of the disabled elderly. Thus, the core of societal preparation for the aging of the population is generally considered to be the expansion of services for the disabled elderly. However, gerontological studies on the health status of the elderly conducted in Japan show that the prevalence of disability is quite low and even decreasing. Relative to the services for the disabled elderly, preventive services for the healthy elderly have long been overlooked. In 1994, the Metropolitan Tokyo Government organized a task force to develop a new health education program as the preventive health service for the healthy urban elderly. A preliminary plan outlining the health education program consisting of propagation with a booklet, on-the-job training of practitioners, and development of new curricula and teaching materials was proposed by the authors for discussion within the task force. Although the inquiry has just begun and the plan is still nascent, it seems adequate to fit the needs for preventive health services in the near future.     

Population Ageing in Japan: A Brief Survey

During the next fifty years, the absolute number of elderly in Japan will increase while the absolute number of children and persons in the working age groups will decline. The main cause of this demographic trend is low fertility, which can in turn be traced mostly to delayed and foregone marriages. Absent policy measures and sociocultural change to reduce young women's opportunity costs of marriage and childbearing, it is difficult to imagine this demographic situation changing. Policy makers have stressed the importance of keeping elderly workers in the labour force. However, the problem is not elderly labour force participation per se (which is already very high for a country with Japan's per capita income) but rather the relatively low productivity of elderly workers, who are often employed part-time, work informally in private unincorporated enterprises, etc. Reforms to Japan's public pension system, which is essentially financed on a pay as you go basis with benefits linked to wages, have not been very effective to date. Official projections call for steep increases in the payroll contribution rate. In contrast to the pension system, the Japanese health system has managed to deliver high-quality care at a relatively low cost as measured by health spending as a proportion of GDP. More must be done, however, to expand the availability of long-term disabled elderly. The article concludes with a few observations elicited for European policy makers.     

A scope-of-practice survey leading to the development of standards of practice for health promotion in higher education

To review and analyze the scope of practice of health promotion services and draft standards of quality indicators for higher education communities, the American College Health Association (ACHA) initiated a Task Force on Health Promotion in Higher Education in May 1996. Members of the task force developed a National Survey on Health Promotion and Education in Institutions of Higher Education and mailed the survey to a stratified random sample of 600 ACHA member institutions, as well as to 97 key "best-practice health promotion leaders". The larger sample produced a 75.3% response rate, and 90.7% of the key informants returned usable surveys. The authors report selected findings from both groups that chronicle the state of health promotion practice in higher education at the close of the 20th century. The task force used the findings to establish a data-driven framework for the Year 2001 Standards of Practice for Health Promotion in Higher Education.     

Mental health and the aging: A review of the literature for clinical social workers

This article is a review of the literature on recent trends in mental health services to the elderly. The focus is on clinical services to elderly living outside of mental hospitals but includes services to residents of community nursing homes and homes for the aged. It is concluded that there is currently a non-system of services failing to meet present mental health needs. Current restrictive government reimbursement policies and national health insurance proposals are focused on treatment for acute episodic illness. This orientation does not permit a broader preventive perspective or a comprehensive mental health care approach.     

Defined contribution health benefits

This Issue Brief discusses the emerging issue of "defined contribution" (DC) health benefits. The term "defined contribution" is used to describe a wide variety of approaches to the provision of health benefits, all of which have in common a shift in the responsibility for payment and selection of health care services from employers to employees. DC health benefits often are mentioned in the context of enabling employers to control their outlay for health benefits by avoiding increases in health care costs. DC health benefits may also shift responsibility for choosing a health plan and the associated risks of choosing a plan from employers to employees. There are three primary reasons why some employers currently are considering some sort of DC approach. First, they are once again looking for ways to keep their health care cost increases in line with overall inflation. Second, some employers are concerned that the public "backlash" against managed care will result in new legislation, regulations, and litigation that will further increase their health care costs if they do not distance themselves from health care decisions. Third, employers have modified not only most employee benefit plans, but labor market practices in general, by giving workers more choice, control, and flexibility. DC-type health benefits have existed as cafeteria plans since the 1980s. A cafeteria plan gives each employee the opportunity to determine the allocation of his or her total compensation (within employer-defined limits) among various employee benefits (primarily retirement or health). Most types of DC health benefits currently being discussed could be provided within the existing employment-based health insurance system, with or without the use of cafeteria plans. They could also allow employees to purchase health insurance directly from insurers, or they could drive new technologies and new forms of risk pooling through which health care services are provided and financed. DC health benefits differ from DC retirement plans. Under a DC health plan, employees may face different premiums based on their personal health risk and perhaps other factors such as age and geographic location. Their ability to afford health insurance may depend on how premiums are regulated by the state and how much money their employer provides. In contrast, under a DC retirement plan, employers' contributions are based on the same percentage of income for all employees, but employees are not subject to paying different prices for the same investment.     

Meeting the mental health needs of elderly clients

1. Older individuals in both community and institutional settings have traditionally underused mental health services. Providers of such care devote a minimum of their professional time to those over 65 years of age. 2. Ageism and difficulty with diagnosis are the most frequent explanations for inadequate mental health care to the elderly. This study found that lack of referrals and failure of the aged to seek services partially accounted for underuse. 3. Legislative changes mandating that aged persons be screened for and receive appropriate mental health services will increase the demand for qualified providers. 4. Nursing's approach to care of the older adult, which focuses on both physiological and psychological needs, can facilitate the delivery of comprehensive effective mental health interventions in and out of the institutional setting.     

Adapting the selective periodic health exam to a college-aged population. Joint American Preventive Services Task Force. Canadian Task Force on Health Care Screening

The periodic health examination is a group of tasks carried out by physicians at regular intervals, but not always yearly. It is designed to determine either the risk of subsequent disease or to identify disease in its early, asymptomatic state. These tasks include immunizations, health promotion topics, and specific clinical screening maneuvers. This paper seeks to increase awareness of the extensive work being done by the Canadian Task Force on Health Care Screening and the Joint American Preventive Services Task Force in setting standards for the periodic health exam. The exam can be reviewed in the office and urgent-care setting or promoted in health education activities. Knowledge of the new standards for the periodic health exam can help in setting priorities for preventive activities in student health services. Implementation in the college-aged group will require cost considerations.     

The effectiveness of health care cost management strategies: a review of the evidence

This Issue Brief discusses the evolution of the health care delivery and financing systems and its effects on health care cost management and describes the changes in the health care delivery system as they pertain to managed care. It presents empirical evidence on the effectiveness of managed care and concludes with an analysis of the potential of future health care reform to influence the evolution of the health care delivery system and affect health care costs. Between 1987 and 1993, total enrollment in health maintenance organizations (HMOs) increased from 28.6 million to 39.8 million, representing an additional 11.2 million individuals, or 4 percent of the U.S. population. At the same time, new forms of managed care organizations emerged. Enrollment in preferred provider organizations increased from 12.2 million individuals in 1987 to 58 million in 1992, and enrollment in point-of-service plans increased from virtually none in 1987 to 2.3 million individuals in 1992. In addition, the percentage of traditional fee-for-service plans with some form of utilization review increased to 95 percent in 1990 from 41 percent in 1987. Measuring the effects of the changing delivery system on the costs and quality of health care services has been a difficult task, resulting in considerable disagreement as to whether or not costs have been affected. In a recent report, the Congressional Budget Office recognizes two new major findings. First, managed care can provide cost-effective health care at a level of quality comparable with the care typically provided by a fee-for-service plan. Second, independent practice associations can be as effective as group- or staff-model HMOs under certain conditions. In the future, we are likely to see a continued movement of Americans into managed care arrangements, an increase in the number of physicians forming networks, a reduction in the number of insurers, an increase in the number of employers joining coalitions to purchase health care services for their employees, and a health care system that is generally more concentrated and vertically integrated.     

Economic and Psychological Benefits from Employment: the experiences and perspectives of mothers of disabled children

This qualitative research explores the perspectives and experiences of employed mothers of disabled children particularly with respect to the potential benefits of employment. Forty families with at least one disabled child, representing a variety of family structures and work situations, participated in semi-structured interviews. The findings of this study clearly illustrate that the economic, psychological and social benefits for mothers of disabled children from participation in paid work are strikingly similar to those for employed mothers of non-disabled children. This suggests that the low level of labour force participation of mothers of disabled children in comparison with other mothers is most likely a consequence of the inherent ideological and structural barriers these women face, rather than their qualitatively differing needs. Streamlining of the benefits system, integration both within and between health, education and social services, increased flexibility in the workplace, and dialogue and co-ordination between all of these elements, may go some way to providing the support these mothers need.     

残疾儿童心理健康内涵及结构初探

心理健康是儿童生活和健康成长的保障,相较于普通儿童,在某些方面具有障碍或缺陷的残疾儿童更容易出现情绪和行为问题,其心理健康状况堪忧,迫切需要得到更多的关注和有效的干预.本文基于心理健康的概念和标准,结合残疾儿童的身心发展特点,厘清了残疾儿童心理健康的内涵,其实质是努力达成残疾儿童与外界环境的适度平衡和内心的和谐,即良好的社会适应.在此基础上,从社会适应心理机能的活动领域和特质内容两个维度入手,初步构建出残疾儿童心理健康的五领域(自我意识、人际交往、学习适应、生活适应、社会支持)与三内容(认知、情绪情感、意志行为)相交叉的二维结构模型,为进一步开展残疾儿童心理健康教育的实践工作奠定理论基础.     

Paying for the health and social care of the elderly

The aging population of Japan is causing serious concern among social policymakers. The most urgent issue is to find a way to pay for the health and social care of the frail elderly. After universal coverage of pension and health insurance was achieved, but just before the economic growth rate was considerably slowed, in part, because of the oil crisis, the Japanese government more than doubled pension benefits and made medical care for the elderly free. Since the early 1980s, the government has tried hard to cut and control these benefits, only with moderate success. With a consumption tax rate of only 5%, rather than the proposed 7%, the government is now considering establishing a new health and social care insurance scheme for the elderly to finance the increasing cost of their care.     

Parent-Professional Power Relations: parent and professional perspectives

This paper reflects on a small-scale qualitative research study around the establishment of a conductive education centre in a city in the north of England. From the outset, the centre's existence presented a challenge to existing services because the monopoly control of existing professional practice and policy was under question. The research does not offer an evaluation of the effectiveness of conductive education. The task was to examine the centre's provision in relation to existing statutory services, and provide a forum for informed discussion relating to the provision and organisation of multi-professional services for disabled children. The paper suggests that, although there was a mutual tension between the centre and professionals, a number of pointers could become a starting point for a more equitable partnership between parents and existing service providers. We also argue, however, that such a notion of partnership is limited without the voices of disabled people.     

The periodic health examination in college students revisited.

The periodic health examination is a group of tasks carried out by physicians and nurses at regular intervals, but not always yearly, to determine either the risk of subsequent disease or to identify disease in its early, asymptomatic state. The Guide to Clinical Preventive Services, published in 1989 by the United States Preventive Services Task Force, sets common American standards for these procedures. The guide lists those preventive activities recommended for persons aged 19-39 years. Every patient encounter in our student health services should be considered an opportunity for preventive activities. This article offers a simple check list for office use.     

Exercise, health, and aging

The aims of this study were to examine the level of exercise among elderly people with regard to the current Norwegian recommendations, demographic correlates of exercise, and the relationship between exercise and subjective health among elderly men and women. A representative sample of 3,770 Norwegian men and women between 65 and 97 years of age (mean 75 years) completed a questionnaire. The response rate was 83.4 %. Results showed that 6 % of the participants exercise at the level recommended. The oldest old (>80 years), those who have an illness and use medication, and individuals with lower levels of education and income are the least active segments of the sample. After adjusting for age, marital status, income, and education, results showed that exercise at moderate intensity 3-4 days per week is a significant predictor for positive subjective health.     

失能老年人长期护理的需求规模评估、费用测算与经济效应预测

伴随着失能风险的增加,老年人长期护理问题成为人口老龄化研究的新课题.基于CHARLS等相关数据,改进Markov模型,测算2020—2060年失能老年人长期护理需求规模及费用,并预测经济效应,结果表明:(1)老年人数量呈倒"U"形增长趋势,并于2048年左右达到顶峰,约为4.34亿人;失能老年人呈逐年上升趋势,于2060年达到1.84亿人.(2)失能老年人长期护理费用由2020年的3906.57亿元增长到2060年的44973.16亿元,增长11.51倍,其中轻度、中度和重度失能老年人长期护理费用分别增长8.92倍、15.55倍和21.17倍.(3)老年护理劳动力需求量预测显示,由90.33万人上升到228.98万人,增长2.54倍;机构养老护理型床位需求量预测显示,由241.03万张增长到553.11万张,增长2.29倍;老年护理市场直接经济增量预测显示,由3906.57亿元增长到44973.16亿元,增长11.51倍.基于此,本文提出包括坚持"以制度为基础、以服务为核心、以救助为兜底、以法律为准绳"的基本原则,建立失能动态监控机制,完善养老服务财政补贴制度等政策建议.     

Implementing public policies and services in rural Japan: issues and problems

While the sharply increased services for the elderly in the revised Gold Plan--announced in 1994--are noteworthy, implementation of the revised Plan is expected to present numerous issues and problems, particularly in the rural areas of Japan, because of unique circumstances such as depopulation and the presence of a disproportionately large number of elderly; geographical and physical isolation; a conservative and tradition-bound political climate; and conservative attitudes of the elderly. This article examines the current state of policy implementation, identifying issues and problems that are being encountered in the rural areas of Japan. Such issues as economic and family life, health care, and service delivery for the elderly are examined.     

Uniform assessments and standards of social and health care services.

This paper describes the procedures and methodology used in the development of a model In-Home Care services program for aged and disabled adults in Washington State. This program was designed to replace the existing Title XX chore services program in two geographic regions in which dissimilar chore service usage patterns have been exhibited by similar types of recipients. An analysis of the resultant cost, service utilization, and recipient health status data suggests that in the model program home-based services for the aged and disabled were provided in a more equitable and cost-effective manner than is the case with the existing chore service program in this state.     

Implementing Public Policies and Services in Rural Japan

While the sharply increased services for the elderly in the revised Gold Plan-announced in 1994-are noteworthy, implementation of the revised Plan is expected to present numerous issues and problems, particularly in the rural areas of Japan, because of unique circumstances such as depopulation and the presence of a disproportionately large number of elderly; geographical and physical isolation; a conservative and tradition-bound political climate; and conservative attitudes of the elderly. This article examines the current state of policy implementation, identifying issues and problems that are being encountered in the rural areas of Japan. Such issues as economic and family life, health care, and service delivery for the elderly are examined.