Top > ご連絡など > ケアマネジャーの介護保険NEWS > 【介護支援専門員 NEWS】ケアプラン作成「利用者負担」導入を提示――社会保障審議会
【介護支援専門員 NEWS】ケアプラン作成「利用者負担」導入を提示――社会保障審議会
厚生労働省は11月19日に次回部会を開催し、これらの論点についてさらに議論を深める。
この日、厚生労働省が提示した主な改正ポイントは、「利用者負担」「軽度者に対する給付」「被保険者範囲」「公費負担の引き上げ」の5つで、具体的な提案内容は以下のとおり。
【利用者負担】
●高所得者の利用者負担を引き上げ
●居宅介護支援・介護予防支援(ケアプランの作成)について利用者負担を導入
●介護保険施設を利用する低所得者の食費や居住費を軽減する補足給付について、入所前の世帯の資産を考慮して、支給の要否を決定する
●現在、4人部屋などの多床室の入所者が負担する居住費について、光熱水費のみ負担しているのを、室料負担も求める
【軽度者に対する給付】
●軽度者の利用者負担を引き上げる
●軽度者への生活援助サービスなどの給付縮小
【保険料負担】
●第2号保険料負担について、現在は加入者の人数で決めているのを加入者の給与水準に応じて総報酬額に応じて決める
【被保険者範囲】
●被保険者範囲を現在の40歳以上から40歳未満に拡大する
【公費負担の引き上げ】
●公費負担割合を5割から6割に引き上げ
●調整交付金を外枠化
●補足給付を公費負担化
●地域支援事業を公費負担化
各委員からの意見発表では、木村隆次委員(日本介護支援専門員協会会長)が真っ先に、居宅介護支援費の利用者負担導入について「断固反対」を唱えた。木村委員は「介護保険制度には"自立支援"の理念があり、それを行うためにケアマネジメントが導入されている。利用者負担を導入することは、この自立支援の理念を著しく損なうものであり、介護保険制度の魂を抜くというくらい大きな話だ」と声を荒げた。
反対理由の筆頭には、ケアプラン作成時の利用者負担がケアマネジメントの利用抑制をあげて、ケアマネジメントにおける利用者負担を嫌ってセルフケアプランの増加も見込まれるが、行政の窓口で個々のケアプランに対応できるのか、保険者側の体制整備も疑問視した。
また、自己負担をすることにより、利用者からは「言うとおりのケアプランを立てて」といったわがままが発生するとケアプランの内容への弊害を指摘、事業者経営への影響についても「特定事業所加算は利用者が良い事業所評価をする指針として設けられたのではないか。利用者負担を導入すれば、料金が安い方に流れるのは必至」と述べた。
さらに災害時や熱中症などの対応や安否確認などの例をあげて、ケアマネジャーが利用者の暮らしを支えていると、功績を強く主張した。
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