介護保険制度 高齢者も応分の負担が必要だ

The Yomiuri Shimbun October 11, 2013
Elderly also need to shoulder fair burden of nursing care cost
介護保険制度　高齢者も応分の負担が必要だ（10月10日付・読売社説）

To maintain the nursing care insurance system, it is impossible to ask only those people who are under retirement age to bear the heavy burdens. It is necessary for the elderly to bear their fair share of the costs.
　介護保険制度を維持するには、現役世代にばかり負担を求めるわけにはいかない。高齢者にも相応の負担が必要だ。

The Health, Labor and Welfare Ministry has submitted to the Social Security Council a draft to review the self-pay rate for nursing care services from the current 10 percent to 20 percent for people earning a certain level of income.
　厚生労働省は、介護保険の自己負担割合について、一定の所得がある場合には、現在の１割から２割に引き上げる見直し案を社会保障審議会に提示した。

The ministry plans to submit a bill to revise the Nursing Care Insurance Law to an ordinary Diet session next year, aiming at enforcing the revised law in fiscal 2015. If realized, it would be the first raise in the self-pay rate since the nursing care insurance system was created in 2000.
　来年の通常国会に介護保険法改正案を提出し、２０１５年度の実施を目指す。介護保険制度が２０００年に創設されて以来、自己負担率引き上げは初めてとなる。

Due to the rapid graying of society, the payment of benefits under the system has been snowballing. It is quite understandable that the government is trying to secure revenue.
　急速な高齢化で、介護保険の給付費は膨らむ一方だ。政府が財源の確保を図るのは理解できる。

The people who will become subject to the increase in the self-pay rate are those with an annual pension income of nearly ¥3 million. About 20 percent of people aged 65 or older meet this criteria.
　自己負担引き上げの対象となるのは、年金だけで年間３００万円近い収入がある人だ。高齢者全体の２０％程度が該当する。

Under the health care insurance system, the self-pay rate of those aged 70 or older and who have a monthly income of ¥280,000 has already been raised to 30 percent. It is inevitable to increase the amount paid for the nursing care insurance system in proportion to income.
　医療保険では既に、現役並みの所得がある高齢者の自己負担は３割に引き上げられている。介護保険についても、所得に応じた負担増はやむを得まい。

The ministry will also review a system to lessen the burden on residents at nursing care facilities for the purpose of spending cuts.
　歳出削減のため、厚労省は介護施設の入居者に対する負担軽減制度も見直す。

At facilities like special nursing homes for the aged, expenses, such as living and meal costs paid by low-income residents, are currently subsidized through nursing care insurance revenue. Under the ministry’s envisioned review, married couples with savings of ¥20 million or more will be excluded from the system.
　特別養護老人ホームなどでは、低所得者を対象に、入居者が負担する食費や居住費を介護保険財源で補助している。その対象から、夫婦で預貯金が２０００万円以上ある場合などを除外する。

Currently, low-income earners are eligible for the subsidies even if they have a huge amount of assets. It is natural to review the system. There are no subsidies for people who receive in-home nursing care services or residents in so-called group homes for the aged, leading some to criticize the system as unfair. This point should be taken into consideration.
　現在は多額の資産があっても補助対象になっている。これを見直すのは当然だろう。自宅で介護を受けている人やグループホーム入居者に補助はなく、不公平との指摘がある点も考慮すべきだ。

Major problems

However, the increased revenue following these measures is expected to reach only about several tens of billions of yen, which is obviously insufficient. We also doubt to what extent the government will be able to determine individuals’ assets since, in principle, the government will rely on self-reporting. These are major points to be studied.
　ただ、これらの措置による財政改善効果は数百億円規模にとどまる見込みで、十分ではない。資産の把握も、自己申告が原則では実効性に疑問符がつく。今後の大きな課題である。

The ministry is now considering removing services for those users who require only low-level nursing care services from the nursing care insurance system and transferring them to programs run by city, town and village governments utilizing volunteers. The ministry is also thinking about changing the criteria for those eligible to enter special nursing homes for the aged from the current “Nursing care required: Level 1 or higher” to “Nursing care required: Level 3 or higher” under the nursing care requirement authorization system.
　厚労省は、軽度者向けサービスを介護保険から外し、ボランティアを活用した市町村の事業への移管も検討している。特養の入居基準も、現在の「要介護１以上」から「要介護３以上」に改める。

We think the direction of the policy, using the limited revenues mainly for people requiring intensive nursing care, is appropriate. The important thing is to make the entire nursing care insurance system efficient.
　限られた財源を重度者中心に振り向ける方向性は妥当と言える。重要なのは、介護保険サービス全体の効率化である。

On the other hand, the welfare ministry will reduce the nursing care insurance premiums of low-income earners, who account for 30 percent of the elderly. It is designed to prevent an increase of the burden on low-income earners if an increase in premiums is unavoidable due to the increase in the number of nursing care service users.
　一方で厚労省は、高齢者の３割に当たる低所得者の介護保険料を軽減する。利用者の増加で保険料の上昇が避けられない中、低所得者の負担増を防ぐためだ。

However, public funds will be required to take such a measure for low-income earners. To ensure that revenue can be secured by increasing the burden on high-income earners, we think the rate and the people entitled to reduced premiums must be limited to the minimum necessary.
　だが、低所得者対策には公費投入が必要になる。高所得層の負担引き上げで財源を確保する効果が失われないよう、保険料軽減の率や対象を絞るべきではないか。

(From The Yomiuri Shimbun, Oct. 10, 2013)
（2013年10月10日01時22分 読売新聞）