Outlook on Changes in the Social Welfare System in Japan: Key Points of Its Basic Structural Reform
Kenji Itayama
Vice President, Japanese Society for Rehabilitation of Persons with Disabilities (JSRPD)
Abstract The year of 1999 seems to be a year of ferment named 'reform' for Japan's social security, especially for the field of social welfare including health and welfare of persons with disabilities. Social security reform, which is making its way at a high pace, is recognized as part of 'Six Reforms' that are taken over from the Hashimoto administration (1996-98) to the Obuchi administration (1998 forward). This paper tries to discuss the recent trends and some issues of 'Basic Structural Reform of Social Welfare' in Japan.
Introduction
The year of 1999 seems to be a year of ferment named "reform" for Japan's social security, especially for the field of social welfare including health and welfare of persons with disabilities.
While reform of the medical care and the pension systems is under way and the course has been mapped out for enforcement of Personal Assistance Insurance Law, a bill will be brought up to the Diet to amend the Social Welfare Services Law, giving the entire picture of basic structural reform of social welfare system for the first time in 50 years.
The definite reform plan for the three laws related to health and welfare of persons with disabilities, namely the Law for the Welfare of Physically Disabled Persons, the Law for the Welfare of Intellectually Disabled Persons and the Law concerning Mental Health and Welfare for the Mentally Disabled.
Social security reform, which is making its way at a high pace, is recognized as part of "Six Reforms" (i.e., public administration, public finances, social security, economy, financial systems and education) that are taken over from the Hashimoto administration (1996-98) to the Obuchi administration (1998-). It is hoped that these reforms will function as a safety net for people living in the "aging society with fewer children" in the 21st century's.
Here I would like to take this opportunity to discuss the recent trends and some issues of "Basic Structural Reform of Social Welfare".
Seven Key Words" in Welfare Reform
On June 17, 1998, the "interim report" on "Basic Structural Reform of Social Welfare" was released. The report put together the "Basic direction of reform" in the following 7 points.
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To establish a relationship that places service users and renders on even ground;
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To provide comprehensive support for various demand on an individual basis in the community;
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To promote entry of various entities that can meet a wide variety of demand;
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To improve quality and efficiency of reliable and reasonable services;
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To secure transparency of service operations by means of information disclosure;
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To bear equal and fair shares of expenses on the rise; and
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To create welfare-oriented culture through citizens' pro-active involvement.
The "interim report", in line with this basic direction, suggested that radical system reform be carried forward, with emphasis placed on "promotion of social welfare services", "assurance of quality and efficiency" and "establishment of community-based services".
In response to the suggestions, the Ministry of Health and Welfare, in cooperation with various parties concerned, drew up "Essentials of System Reform(tentative)", which was reported and approved at the Subcommittee of Basic Structural Reform of Social Welfare on December 8, 1998.
According to the Ministry's official sources, amendment bills of the Social Welfare Services Law and other laws are to be formulated based on the above-mentioned tentative proposal and submitted to the current ordinary session of the Diet. Now I would like to give the outline of the "Essentials".
Four Pillars of the System Reform
1. To build a user-oriented welfare system: (1)
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a. Conversion of services into those on a contractual basis
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To abolish in principle the ongoing government-funded service provision system
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To maintain the public subsidies in status quo
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b. Creation of a user protection system
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To create the community-based service advocacy system and the measures to settle complaints
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2. To improve service quality:
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a. Personnel training and development to support services of high quality
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b. Establishment of independent bodies to evaluate the quality of services
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c. Secured transparency of service operations
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To set an obligation to disclose service details and management information
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3. To enhance diversity and vitality of social welfare services:
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a. Expansion of the scope of social welfare services
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Advocacy services
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Information services for persons with disabilities
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b. Deregulation of requirements for founding a social welfare corporation
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c. Promotion of entry of various service entities
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d. Adoption of flexible management of social welfare corporations
4. To improve community-based services:
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a. Formulation of the "Community-based Service Provision Scheme" (2)
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Establishment of statutory provisions to authorize prefectures and municipalities to formulate the scheme
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Plans to improve infrastructure
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Citizens' involvement
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Cooperation between the public and the private sectors
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b. Activation of the Councils of Social Welfare, Minseiiin (Commissioned Welfare Volunteers) / Jidouiin (Commissioned Child Welfare Volunteers), and the Community Chest
Looking at the "Essentials" illustrated above, although the Ministry of Health and Welfare should be praised for its strong will and efforts to carry out reform, there are a lot of stumpers lying ahead. All parties concerned need to give support with concerted efforts.
Some Issues to be Solved
First, I would like to point out that, although "user orientation" and "users' choice of services" in the social welfare scheme are stressed and measures are taken for advocacy and consultation/support, no concrete countermeasures are set forth to address 1) infrastructure improvement of services in both quantity and variety to deal with users' choice of services and 2) the issue of costs to be borne by users.
The second issue is the importance of administrative and financial measures taken by municipalities to deal with their growing role including formulation of the "Community-based Service Provision Scheme". Municipalities occupy the crucial position in the field of social welfare.
The third is the issue of the amendments to the laws related to children, persons with disabilities, elderly people, and so on. Beyond the inter-office conflicts of interest, needed is reform with principles and exceptions in balance. It is not too much to say that the Ministry is under pressure to prove its ability.
Finally, "reform" is always accompanied by some pain. As the welfare system is a plank for people's life and living, it is desired to conduct the welfare reform that can minimize the pain on the part of users.
Notes
1. One important aspect common to various changes in the social welfare system for persons with disabilities is the systemizing of user-oriented operation of welfare services. At present, the details and providers of services are identified and determined by the government, and the government pays the service fee to service providers, not by way of users. Under the current system voice of users often fail to be reflected. This ongoing government-funded service provision system will be converted to a new user-oriented scheme, which allows users to stand on even ground with providers while making their own choice of services. The public subsidies should be expected to maintain as it is.
2. As regards the persons with disabilities, a deliberation will be carried out for the comprehensive review of services rendered at home and in institutions. The improved services will include: systematized social rehabilitation services, additional day services, promotion of social participation through improved accesses to communication for persons with hearing impairment that include clarifying the systems of training and dispatch of sign language interpreters and guide dog training, and alleviating the requirements of various facilities. These changes are to be considered from the standpoint of supporting independent living in the communities for persons with disabilities.
A discussion will be held regarding medical care and welfare services for persons with psychiatric disability so that they will be thoroughly carried out in the way their human rights are taken into consideration. Also to be discussed is the creation of welfare services to support the community life of persons with psychiatric disability staying at home, in which case local municipal governments will play a major role.
Asia and Pacific Journal on Disability
Vol. 2, No. 1, May 1999
Contributed by Mr. Tsuyoshi Takeda, Asahi Shimbum Newspaper
ISSN 1029-4414