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).

Elderly care is an emerging global issue threatening both developed and developing countries. The elderly in Japan increased to 26.7% of the population in 2015, and Japan is classified as a super-aged society. In this article, we introduce the financial aspects of the medical care and welfare services policy for the elderly in Japan. Japan's universal health insurance coverage system has been in place since 1961. Long-term care includes welfare services, which were separated from the medical care insurance scheme in 2000 when Japan was already recognized as an aging society. Since then, the percentage of the population over 65 has increased dramatically, with the productive-age population on the decrease. The Japanese government, therefore, is seeking to implement "The Community-based Integrated Care System" with the aim of building comprehensive up-to-the-end-of-life support services in each community. The system has four proposed elements: self-help (Ji-jo), mutual aid (Go-jo), social solidarity care (Kyo-jo), and government care (Ko-jo). From the financial perspective, as the government struggles against the financial burdens of an aging population, they are considering self-help and mutual aid. Based on Japan's present situation, both elements could lead to positive results. The Japanese government must also entrust the responsibility for implementing preventive support to municipalities through strongly required regional autonomy. As Japan has resolved this new challenge through several discussions over a long period of time, other aging countries could learn from the Japanese experience of solving barriers to healthcare policy for the elderly.

[Effects of healthcare advice with particular focus on metabolic syndrome: differences by advice level from National Health Insurance data].

OBJECTIVES: The Health Checkups and Healthcare Advice with Particular Focus on Metabolic Syndrome (Tokutei Kenshin Hokenshido) started in 2008. In this study, we examined the effects of healthcare advice with attention to the difference in effect according to the level of advice. METHODS: We used data from insured individuals who received health checkups in 2008 and 2009, and healthcare advice in 2008 under the National Health Insurance system, in all municipalities in Yamaguchi prefecture. The numbers of subjects were 155 for intensive advice (Sekkyokuteki) and 735 for moderate advice (Doukizuke). We compared the changes in the results of health checkups according to the level of advice, and examined the effect adjusted for sex, age, and baseline data of health checkups in 2008. RESULTS: Other than systolic blood pressure and hemoglobin A1c, all items showed a significant improvement in all the subjects. The improvements in body weight, BMI, waist circumstance, and HDL-cholesterol in subjects who received intensive advice were significantly larger than those in subjects who received moderate advice. However, among the subjects under 65 years old, only waist circumstance and FBS showed a significant difference between intensive and moderate advice. After adjustment for sex, age, and baseline data, there was no relationship between the level of advice and the change in results of health checkups. CONCLUSIONS: Although our findings are not conclusive and further studies are required, they suggest that the effects of intensive and moderate advice are not significantly different. In addition to improving the effect of healthcare advice, a rethinking of provision of healthcare advice is essential: moderate advice might be more appropriate considering the limited resources and budget in communities.

[Quasi-experimental study of effects of "Healthcare Advice with Particular Focus on Metabolic Syndrome"].

OBJECTIVES: The "Health Checkups and Healthcare Advice with Particular Focus on Metabolic Syndrome" (Tokutei Kenshin Hokenshido) started in 2008. We conducted a quasi-experimental study to elucidate the effects of healthcare advice. METHODS: We used data from insured individuals who received health checkups in 2008 and 2009 under the National Health Insurance system, in all municipalities in Yamaguchi prefecture. We compared changes in the findings of health checkups in 2008 to 2009 between intervention subjects who received healthcare advice from 2008 and control subjects who did not receive advice. The control group was matched with the intervention group in terms of area, sex, age, and level of advice. RESULTS: Data from 786 subjects in the intervention group and 1224 in the control group were analyzed. The following showed significant differences in the change in health checkup data between the intervention and control groups: body weight, -1.1 kg; BMI, -0.4 kg/m(2); waist circumstance, -1.1 cm; triglyceride, -6.7 mg/dl; HDL-cholesterol, +1.0 mg/dl; LDL-cholesterol, -2.4 mg/dl; GPT, -1.4 IU/dl; γGTP, -2.4 IU/dl. There was no significant difference in blood pressure, FBS, or HbA1c. CONCLUSIONS: This quasi-experimental study demonstrated a moderate but significant effect of healthcare advice, although several items including blood pressure and blood glucose did not show significant improvement.