介護報酬削減 職員の待遇改善と両立させよ

The Yomiuri Shimbun
Balance nursing care fee changes with better conditions for workers
介護報酬削減 職員の待遇改善と両立させよ

To maintain the nation’s social security system in a rapidly aging society, it is vital to curb ever-soaring nursing care expenses.

The government has decided to cut nursing care service fees under public nursing care insurance by 2.27 percent overall, starting in fiscal 2015. The move is the first downward revision in fees in nine years and the second largest cut on record following reductions of 2.3 percent in fiscal 2003.

Nursing care fees are paid to nursing care providers in compensation for the services provided under the public insurance system.

The total expenses of the nursing care insurance program, which stood at ¥3.6 trillion in fiscal 2000, when the system started, reached ¥10 trillion in fiscal 2014. The expenses are expected to double within the next 10 years.

With a 1 percent cut in nursing care fees, total expenses are calculated to be trimmed by ¥100 billion a year. As the planned hike in the consumption tax rate to 10 percent has been postponed by a year and a half and the task of securing revenue sources for social security programs has consequently been delayed, the government will inevitably cut nursing care fees to curb overall expenditures.

Meanwhile, the planned cutback will not only ease the government’s fiscal burdens, but also reduce insurance premiums paid by insured and service users.

The Finance Ministry had originally demanded that nursing care fees be cut by about 4 percent. But should the business conditions of nursing care providers markedly deteriorate, they may have to lower the quality of their services.

Serious manpower shortage

The latest revision can be construed as one resulting from the government taking into account both its fiscal condition and the business operations of service providers.

With regards to better working conditions for nursing care workers, the government will allot extra fees to nursing care benefits for providers that deal with the issue systematically.

Manpower shortages have reached serious levels at workplaces of nursing care services, primarily stemming from low salaries. The average monthly wage for nursing care workers is ¥220,000, which is ¥100,000 less than the average across all industries. How appropriate, then, that the government has set aside extra outlays to raise the monthly average wage for nursing care workers by about ¥12,000.

To ensure the extra outlays will be reflected in wage hikes, public administrators must be adamant in making regular inspections.

In fiscal 2025, when members of the baby-boomer generation will be 75 or older, projections indicate the need to increase the number of nursing care workers by 1 million. Nursing care providers need to make great strides to improve the working conditions for nursing care workers.

The Health, Labor and Welfare Ministry will decide on fees by type for nursing care services in the days ahead. The ministry is planning to increase rewards for at-home services supporting those requiring high or moderate levels of nursing care, as well as at-home services that assist elderly citizens with dementia.

Meanwhile, the government will drastically cut service fees for special elderly homes providing round-the-clock nursing care because operators of such facilities are said to have amassed profits averaging ¥300 million. There are said to be not a few of those operators that have neglected to improve their facilities and working conditions for their employees.

Financial conditions differ among service operators. The government would cause more harm than good with these across-the-board cuts in fees if operators that had been striving to improve their services end up in financial hardship.

The ministry needs to work out a framework that accordingly rewards providers offering good services by, for instance, finding ways to enhance the fees paid to them.

(From The Yomiuri Shimbun, Jan. 14, 2015)

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