ケアサポート９／ケアマネージャー（介護支援専門員）試験／ＴＯＰへ

介護保険、給付と負担の両方の見直し必要―厚労省・土生振興課長

土生課長は講演で、自公政権と民主党を中心とする現政権について、介護分野だけを見るとそれほど方向性に断絶はないとする一方で、負担をどうするかというところに違いがあると述べた。
　また、現政権下では、「まずは無駄の排除を徹底するという段階に今ある」とした上で、「介護保険も、これからさらに拡大するニーズを何らかの形で国民みんなで負担していただかなければならない」との見方を示した。
　さらに、「こうした課題を次期報酬改定の中でどのようにこなしていくかは、おそらく来年、集中的に議論が必要になってくるのではないか」と述べた。

　質疑応答で土生課長は、日本の介護保険制度の持続可能性に関連して、給付と負担の見直しについて言及し、「どちらかということではなく、両面を見ることが必要ではないかと思う」とした。
　給付の範囲については、「保険として皆さんに負担いただいている以上、ある程度サービスを広く提供する姿を見せることも、国民の理解を得る意味で必要だと思う」と述べた。
　負担については、「これまでは障害者サービスとの統合と絡められて議論してきたが、やはり介護保険は単体として被保険者の範囲が今のままでいいのかどうか、もう一回議論をするべきだろうと思っている」と語った。
　また、公費割合を拡大することも選択肢として考えられるが、税制改革と一体でなければならないとし、「特に税収が落ち込んでいる中で、国家財政的には大きな議論が必要と考える」と述べた。

　シンポジウムではこのほか、韓国の翰林大社会福祉学科の石才恩副教授が、昨年7月から導入された「老人長期療養保険制度」について報告した。石副教授は、利用者などを対象とした満足度調査結果では、利用者の健康や生活の質が向上したり、家族の負担が軽減されたりといった結果が報告されたとする一方で、介護サービス事業者の過当競争や訪問介護へのサービスの偏重、家族がケアワーカー資格を取った場合、資格がない場合よりも多く給付されるなどの不公平が生じているとした。また、現在3段階設定している「要介護度」についても、中重度が対象のため、どこまで軽度者を対象とするかといった課題もあると述べた。

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