Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
In Reply.—I agree with Dr Manning that
social problems have been frequently, and inappropriately, thrust onto the
medical care system. However, this is precisely the reason new public LTC
insurance was established in Japan as a separate system distinct from the
existing health insurance system. Where Dr Manning and I disagree is that
he thinks LTC legislation is "unequivocally a social problem related to family
support or its absence." I believe that while the social aspects are important
because it is difficult to draw a line between LTC and ordinary life, a good
LTC system should also integrate medical and social care. Therefore, although
physicians will be playing a less dominant role in LTC in comparison with
acute medical care, medical supervision will continue to be an important component.
Without it, a chronic medical condition, such as diabetes or arthritis, that
could be improved with medical attention or rehabilitation will be seen as
an untreatable functional impairment that requires only care and support.
I hope other physicians will agree and take an active interest in LTC as it
will play a growing role in the aging society. In Japan, public LTC insurance
legislation has passed the Diet on December 9, 1997, so that it will be implemented
as planned in the year 2000.
Ikegami N. Long-term Care in Japan and the United States: A Medical or Social Issue?—Reply. JAMA. 1998;279(10):747-748. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-10-jac80000