January 2003 "The New Basic Plan for the Disabled" and the Subsidy System ("Shien-hi Seido") for the Disabled
gThe New Basic Plan for the Disabled" and the Subsidy System ("Shien-hi Seido") for the Disabled
Ministry of Health, Labor and Welfare
General budget
April 2003
Detailed description of the reform
Until now, a large portion of the disabled population are in institutions under what was called "Sochi (placement) " system. "Sochi" means that the government assessed the needs of the disabled and placed the person in an institution which it thought as the most appropriate. However, the 1997 Structural Reform of Social Welfare has put forward an objective to establish a system that ensures the choice of individuals. This is the first attempt to actually put this objective in practice.Nearly 30% of the mentally disabled persons in Japan are institutionalised. Many are institutionalised for a long period, and only a handful ever return to the community.
The New Basic Plan places the emphasis on de-institutionalizing the disabled population and allow them to live in the community. The Plan further plans to include the disabled persons themselves in the policy making process, and to promote the employment of the disabled persons.
The disabled
gSubsidy (Shien hi) System" replaces the "Placement (Sochi(" System. Under the Placement system, the government formed the contract the service providers and "placed" the disabled persons in their care. However, under the new system, the disabled persons themselves choose the supplier of the services they require and form a contract with it. The subsidy is then paid from the municipality to the supplier of the services. However, the government is considering to put the upper limit on the number of hours that a person can receive the care at home, out of the concern that the welfare needs for the disabled will increase and the financial shortage will occur.
It is critical the the level of services is kept-up under the new system.
Freer Choice for the disabled.
Not yet seen.
The long-term Care. At the time that the Long-term Care insurance was introduced, there was an argument to include the disabled persons under the insurance as well as the elderly. However, the financial standing is very different from the elderly and the disabled, and the co-payment was considered to be too expensive for the disabled. Now, the discussion is again on-going to merge the long-term care for the elderly with the care for the disabled.
There are a lot of criticisms regarding what is going to happen in April, mainly from the disabled persons' associations. First criticism is that even though the new system boosts the "freedom of choice" , there are not enough service providers to choose from, and the disabled persons are bound to the institutions. Second and the biggest criticism is the upper limit of the at-home care services. This not only prevents the institutionalised people from leaving the institutions, it also cuts the life-line of many disabled people currently living in the community by receiving a lot of care, free of charge provided by the municipalities.
Similar argument was raised at the time of the introduction of the Long-Term Care Insurance. The current problem of the Long-term Care Insurance and also probably the biggest issue regarding this reform is what to do with people with low income. It is especially the case for the disabled persons, whose employment is very low in Japan. The employment, and therefore means for the disabled persons to provide for themselves as well as to cover at least part of the cost of the care, must also be seriously taken care of.
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