Medical and Nursing Care: Strengthen Financial Foundation of Services for Aging Population

As the aging of the population progresses, the need for medical and elderly care services will only increase. To prepare for the future, it is necessary to stabilize the financial conditions of medical institutions and elderly care facilities, as well as to secure human resources.

The government has begun discussions of the revision of medical service fees and nursing care fees for fiscal 2024. The rate of increase or decrease will be decided when the budget is compiled at the end of the year. Medical service fees, meaning the price of medical treatment, are revised every two years, while nursing care fees are revised every three years. This will be the first simultaneous revision in six years.

In 2025, all members of the baby boom generation will be 75 or older, and the number of people requiring medical and nursing care will further increase.

In the revision, it will be important to establish a system that allows the public to receive treatment and services with peace of mind. The conventional argument biased toward lowering fees cannot be accepted.

A key issue in the revision of medical service fees will be how to respond to the “reforms for work-life balance for doctors,” which will begin in April next year. Since overtime will be limited, in principle, to 960 hours per year for employed doctors, consideration should be given to allowing nurses and others to take on some of the duties of physicians.

It is also important to promote greater efficiency than before, such as by reducing excessive hospital visits and drug prescriptions, in order to limit the increase in the burden on the public.

Meanwhile, in the revision of nursing care fees, there is an urgent need to address rising costs. Even if electricity bills or food prices rise, it is difficult for nursing care facilities to respond to the changes because their fees are set by the state.

According to a survey by the Japanese Council of Senior Citizens Welfare Service, 62% of special nursing homes for the elderly were in the red last fiscal year. This is the first time for the figure to exceed 60%. Businesses where users do not reside, such as day care services and home visit services, are especially burdened by fuel costs.

Some facilities reportedly have been making painful efforts to save electricity, such as by using fewer light bulbs and having staff refrain from using elevators.

If financial conditions become unstable and operations cannot continue, the lives of users and their families may be affected. The government should take supportive measures, such as raising nursing care fees and subsidies.

The shortage of nursing care workers is also a serious problem. According to a survey by the Health, Labor and Welfare Ministry, 540,000 people entered the nursing care field last year, while 610,000 people left it.

While nursing care workers have the responsibility of taking care of the health and lives of the elderly, their wages are low. In particular, in this year’s spring labor-management wage negotiations, wages for full-time employees have increased across a broad range of industries, thus widening wage gaps between the nursing care sector and other industries, which could be one reason why many workers are leaving the elderly care sector.

To secure human resources, improving the treatment of nursing care workers is an urgent task. Increasing the number of foreigners working in the nursing care field must also be considered.

(From The Yomiuri Shimbun, Oct. 31, 2023)