Medical Evaluation in the Certification of Long-term Care and Support Needs : An Analysis of the System Design Process with A Focus on the Family Doctor Opinion Documents

Fujiwara Rieko

doi:10.18910/86420

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要介護・要支援認定における医学的評価の在り方 : 主治医意見書を中心とした制度設計過程の分析
ヨウカイゴ　ヨウシエン　ニンテイ　ニ　オケル　イガクテキ　ヒョウカ　ノ　アリカタ　シュジイ　イケンショ　ヲ　チュウシン　ト　シタ　セイド　セッケイ　カテイ　ノ　ブンセキ
ヨウカイゴ・ヨウシエンニンテイニオケルイガクテキヒョウカノアリカタ : シュジイイケンショオチュウシントシタセイドセッケイカテイノブンセキ

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Abstract

This paper examines the process of creating the procedure of the family doctor opinion documents, which is important in the certification system of long-time care and support needs launched in October 1999, a half year before the establishment of a nursing care system. More specifically, the purpose of this paper is to clarify why and how the certification system based on a single opinion by a medical specialist was established while a more comprehensive evaluation has been required. As a conclusion, these facts resulted in the current system that emphasizes the importance of a single doctor’s opinion: the practicality of the opinion documents was given priority and the intentions of the Japan Medical Association was strongly reflected in the conflicts and adjustments between nursing and medical care. As the problems in the process, there was a lack of the system that included the diversity of discussions, the construction of the foundation for the smooth operation and the flexible modification. Concerning a better system to properly understand the health status of the elderly in the certification of long-term care and support needs, this paper suggests the need for the overarching and objective medical evaluation based on the multiple doctors’ opinions.

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Co*Design

Co*Design 11 155-179, 2022-02-28

大阪大学COデザインセンター

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