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March 11, 1998

Long-term Care in Japan and the United States: A Medical or Social Issue?—Reply

Author Affiliations

Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1998

JAMA. 1998;279(10):747-748. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-10-jac80000

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.

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