福祉政策の国際比較の利点：
日本とドイツの介護保険制度の比較を通して
'
BenefitsofStudyingotherCountries'WelfareSystems,
throughaComparisonofGermanand
JapaneseLong-
Term CareInsuranceSystems
田中 和奈
HarunaTANAKA
Abst
r
act
Improved medicaltreatmentand living conditionshave produced an ageing society in many advanced countries.Therefore,manyadvancedcountriesstudyothercountries'socialpoliciesinordertofindandmeet thedemandsofanageingsociety.Tocopewiththedemandofanageingsociety,GermanyandJapanhave introducednew policiessuchaslong-term care.JapanissimilartoGermany,inthatitisanageingsociety,thus JapanesescholarsstudiedtheGermanLong-Term CareasamodeloftheJapaneseLong-Term CareInsurance system.However,bothcountrieshaveadifferentcultureandhistory.Asaresult,JapanalteredtheGerman Long-Term CaretofittheJapanesecultureandenvironment.Thisisoneexampleofhow acountrymay implementothercountries'socialwelfaresystemstodealwithpublicdemands.
KeyWords:welfare,comparison,Long-Term CareInsuranceSystems
Ⅰ．I
nt
r
oduct
i
on
Comparingandevaluatingothercountries'welfaresystems,welfaretheory,andpolicymakingpracticesare importantpracticesfortoday'ssocieties.Studyingthesituationsofdifferentwelfaresystemshelpsgenerate new ideas,andthereforemanyspecialistsexamineothercountries'welfaresystemstofindsolutionstotheir ownsocialwelfareproblemsintheirowncountries.Examiningothercountries'welfaresystemscanalsohelp withpolicymakingpractices.
Inrecentyears,anageingsocietyhasbeenabigproblem inJapan.Therefore,Japanesescholarsexamined Germany'slong-term care(LTC)system anduseditasabasisforJapanintheyear2000.
Inthispaper,Iwilldiscussthebenefitsofstudyingothercountries'welfaresystemsbothinwelfaretheory andpolicymakingpractices,andexamineJapan'slong-term careinsurance(LTCI)system asanexampleto supportmydiscussion.
Ⅱ．Whati
st
heor
y?
Itisdifficulttoidentifywelfaretheory.ThompsoncitedthatChinnandKramerarguedthemeaningof 'theory'１）
"Defining'theory'canbecomplex,andultimatelymostpeopleacceptanarbitrarymeaning.Justwhena definitionseemsfirm,anotherideasurfacesthatmustbeintegratedintoit.Likemostterms,bothwithin andoutsidetheprofessionofnursing,theoryhascommon,everydayconnotationsapparentinsuchphrases as… 'Ihaveatheoryaboutthat'or… 'mytheory is… '.Theseusagesimplythattheoryisanideaor feelingorthatitexplainssomething."
Itshowsthattheterm of'theory'isusedindifferentwaysanditdoesnothaveadecisivedefinition. Midgley argued thatsocialpolicy theory isclosely related with governmentalsocialprovisionsand he indicatedthreemajortopicsofsocialpolicytheory２）:
1.theconstructionofrepresentationalconceptionsofstatewelfareprovision
2.theorybuildinginsocialpolicyistheexplanationoftheoriginsandfunctionsofstatewelfareprovision 3.socialscientistsinthefieldofsocialpolicyistheformulationofnormativetheories
Applyingrepresentationaltheory,socialscientistscancategoriseandunderstandsocialwelfareproblems. Midgley discussed that "representationaltheory uses models ofsocialwelfare to create typologies or taxonomiesofstate welfare"２）.Typologiesare used widely to categorise intricate circumstances.These typologiesareusefultounderstandandcopewithcomplexcases.Oneofthemostfamoustypologiesisdefined by Swedish writer Gosta Esping-Andersen.He argued a three-part typology in which the idea of decommodification playsanimportantpart２）.Esping-Andersenstudiedtwosystems,decommodificationand stratification in histhree typesofwelfare regimes.Esping-Andersen'sidea ofdecommodification may be rephrasedas'peoplecansupportthemselveswithoutdependingonlabour'andthelevelofstratificationisan outcomeofthepattern ofthewelfarestate. Heindicated theprocessofdecommodification oflabourin connectionwiththreetypesof"welfareregimes":theliberalstate,theconservative-corporatistwelfarestate, andthesocialdemocraticwelfarestate２）.Heclassifiedbetween,liberalwelfare,liketheUnitedStateswhich increasingly dependson privatewelfare,conservativecorporatistwelfare,likeGermany which dependson workbasedsocialinsurancesystems,andsocialdemocraticwelfarestates,likeSwedenwhichisdistinguished byahighdegreeoflabourdecomoddification３）.
Anotheruniversalapproachistheglobalisationtheory.Globalisationisknownasaprogressivelysignificant featurenowadays２）.Globalisationanditsinfluencesbecameimportantobjectsofattentioninthelate1990sand politiciansandscholarsoftenstatedarequirementfor"lessstateandmoremarket"inthenew universal world４）.Socialwelfareisbeinginfluencedbythedevelopmentofglobalisation２）.PalierandSykesarguedthat Esping-Andersen indicated thatdifferentnationalsystems answer problems in various ways４）.Different countrieshavedifferentculturesanddifferenteconomicbackgrounds,andthereforeeachcountrytriestosolve their problems individually.However,deciding effective policy is very difficult.To solve socialwelfare problems,studyingothercountries'policyimplementationthroughexamplesisuseful.MoonandNorthargued
that"effectivecomparativeanalysesusuallybeginfrom positionsofsimilaritybetweensystemsorsocieties"５）. Ingeneral,mostspecialistsareinterestedinothercountries'welfaresystems,especiallythosecountriesthat havesimilarbackgroundstotheirown,suchaspopulation,economiccondition,andhealthcaresystems.
Thereareavariety ofapproachestocomparesocialpolicy in othercountries. Higginsidentified nine orientationsincomparativeresearch６）:
1.policyareas 2.problem areas 3.groupsinneed
4.thesocialpoliciesofforeigncountries 5.policyareasinforeigncountries 6.comparisonsoftotalwelfarespending 7.comparisonsovertime
8.'different'and'similar'systems 9.conceptsandissues
Thesenineorientationsindicatethatdifferentconditionsneeddifferentapproaches.Toimplementsuitable policymodelsthatmeetsocialdemands,itisimportanttostudycountrieswithsimilarbackgrounds.Therefore togetcertaininformation,itisalsoimportanttousethesamedatacollectionsystemswhencomparingother countries'statisticaldata.
Piersonarguedthat"thewelfarestateistheproductofastrugglebetweenthepoliticalpowersofsocial democracyandtheeconomicpowersofcapital"７）.KarlMarxandFriedrichEngelsareinterpretersofthe materialistdefinitionofsocialtransformation.Marxinfluencedtheappearanceofinternationalism２）.Marxist scholars indicated how welfare determination responded to inquiries about the economy and political steadiness６）.
Deacon,Hulse,andStubbsarguedthatthefeministinfluenceonliteratureindicatedastandardofwomen friendlinessopposedtocomparewelfarestates３）.TheyalsoarguedthatSiaroffindicatedthattherewerefour OECD regimetypes;ProtestantliberalwelfarestatesliketheUK,advanced Christian democraticwelfare stateslikeGermany,ProtestantsocialdemocraticwelfarestateslikeSweden,and latefemalemobilization welfarestateslikeSpain,Switzerland,Greece,andJapan３）.However,thelatefemalemobilizationwelfarestates donotadvancewomen'swork.JapanisthemostindustriallyadvancedcountryinAsia,however,feminism still lacksinJapan.Japanesehistoryhasinfluencedsocialpolicydebateinhealthandsocialwelfare８）.
SteslickecitedtheargumentoftheEconomicWelfareCouncil８）:
"Overaperiodofabout100yearssincetheMeijiRestoration,Japanhasfollowedthemodelprovidedby theWestinordertoattaintheobjectiveofcatchingupwiththeadvancedWesterncountries.Underthe presentcircumstances,however,Japancannolongerfindanymodelstofollow outsidethecountry,but hastocreateonitsownanew lifestylebestsuitedtoitsnature,climate,historyandsociety（１）."
TheJapanesehealthcareandwelfaresystem hasbeeninfluencedbywesterncountries'welfaremodels, particularlyfrom Germany,Britain,andAmerica８）.OneofJapan'sbiggestsocialproblemsisthatitisan ageing society in common with otheradvanced countriessuch asSweden,Germany,theUS and theUK. Japanesescholarshavestudiedotheradvancedcountries'welfaresystemstosolvetheproblemsassociated withanageingsociety.ScandinavianwelfaresystemswouldbeverydifficulttoadoptinJapanbecauseofthe associationwithhightaxes,whichwouldbringaboutastrongdissatisfactionlevelthroughthecountry.Asa result,theJapanesegovernmentadoptedtheGermanlong-term caresystem asamodel.AlthoughGermany andJapanarebothindustriarisednationsandfacesimilarsocialproblems,suchasanageingpopulation,both countrieshaveadifferentcultureandhistory.Therefore,whenstudyingothercountries'welfaresystems,a countrymustrestructureothercountries'policiestofittheirownsituations.TheJapaneselong-term care insurancesystem isjustoneexampleofthewayinwhichacountrycanchangeanothercountry'spolicies,to fittheirownsituation.
Ⅲ．LongTer
m Car
eI
nsur
ancei
nJapan
Improved medicaltreatmentand living conditionshave produced an ageing society in many advanced countries.Therefore,manyadvancedcountriesstudyothercountries'socialpoliciesinordertofindandmeet thedemandsofanageingsociety.AlmostallJapanesesocialprogramswereintroducedfrom westerncountries and progressed through the study ofother states'experiences９）.However,Japan's aged population has increasedmorerapidlythanelsewhere,thusothercountries'policiescannotbedirectlyapplicabletoJapan's situation.CampbellarguedthatJapanesepolicymakersneedtofindtheirownanswerstosolvetheirproblems ratherthanstudyothercountries'examples９）.However,studyingothercountries'examplesisaneffectiveway tofindsolutionstotheproblem ofanageingsociety.HaraldandRalph10） arguedthat:
"JapanandGermanyhavebeenfacingverysimilarchallenges:ageingpopulations,changingemployment structures,long-lasting economicstagnation,and globalization… .Both countriesarein anumberof respectsmoresociallyandpoliticallyregulated,andinthissenselessliberal,thantheAnglo-American economies."
Tocopewiththedemandofanageingsociety,GermanyandJapanhaveintroducednew policiessuchas long-term care11）.JapanandGermanyhavesimilarbackgroundsandthereforeJapanesepolicymakersstudied Germanlong-term careasamodelandchangedthepoliciestofitJapan'ssituation.KazuhitoIhara,directorof theJapanExternalTradeOrganization'sDepartmentofHealthandWelfare,New YorkCity,suggestedJapan's ageing population isforcing thestatetotakechargeofitslong term careinsurancesystem12）.Although Germany and Japan have similar backgrounds,implementing German long-term care (LTC)posed some problemsinJapan.ThereforeJapanesepolicymakerschangedtheGermanmodeltosuitJapan'sconditions.
Former Japanese Prime Minister Ryutaro Hashimoto announced thatJapan is ready to establish "a sustainablesocialsecuritysystem (jizokusurushakaihoshoseido)",tomeetthedemandofanageingsocietyat （１）SubcommitteeontheLong-Term Projection,EconomicWelfareCouncil,1979,pp.3-4,citedbySteslicke,1989,p.102
apressconferenceduring G-7Lyon Summitin 199613）.Japan laterintroduced along-term careinsurance system in2000anditbecamepartofthesustainablesocialsecuritysystem withinJapan.
TheJapaneselong-term careinsurance(LTCI)program suppliesagedpeoplewithinstitutionalcare,suchas nursinghomesandhealthcarefacilitiesfortheaged,andcommunity-basedcare,suchashomecarenursing andhousekeepingservices11）.JapaneseLTCIisfinanced50% from taxesand50% from mandatorycontributions byemployeesandtheself-employedagedover40.IntheGermanLTC,thereisnoagelimit.AllGermanlabour hastopayintotheGermanLTC regardlessoftheirage.Moreover,Germany'sLTC isfinancedonlyfrom premiums11）.Thefinancesystem oftheJapaneseLTCIisdifferentfrom Germany'sLTC.Japaneseyoung labourarenotreallyconcernedaboutsecurityfortheagedandthusimplementingthesamefinancialsystem liketheGermanLTCwouldbedifficultinJapan.Inrecentyears,manyyoungJapanesedonothaveasteady job,thereforeitwouldbedifficulttocollecttaxesandcontributionsfrom theyoungforasimilarLTCsystem likeGermany.
Inaddition,Germany'sLTChasasystem ofcashallowance.However,Japandidnotadoptthissystem,even thoughmanypeoplehopedthisschemewouldbeintroduced14）.CampbellarguedthatalthoughJapanesesocial welfareprofessionalsknew thecashallowanceschemewouldbeveryeffective,basedontheresultsfrom Germany'sexperiences,theyrejectedtheschemebecauseitdidnotfitJapan'ssituation９）.Healsoidentifiedthe reasonwhichJapanesescholarsrejectedcashallowanceas:
"Theirworry stemsfrom theconventionalimageofthefamily in Japan,in which theson'smother (shutome)essentiallyoppressesherdaughter-in-law (yome)–from thetimetheyome entersthefamily, thoroughmoreandmoreintensivecareoftheoldwoman,untiltheyome's burdenisrelievedbythe shutome'sdeath.Ifoneassumesthiskindoffamilyistypical,thecashallowancewoulddolittletorelieve theburdensofthedaughter-in-law whoistheactualcaregiver."
Thisisatraditionalcustom inJapan,whichproducescomplexproblemsintermsofimplementingacash allowancesystem.AlthoughJapanhasinmanywaysbecomemorewesternized,Japanstillhastraditional Japanesecustoms.GoodmanandPengarguedthatWesternsocialwelfaremodelshavebeenreconstructedto fitthedemandsoftheJapanesenationalaim andJapanese'cultural'orientations15）.Therefore,wecouldsaythat itiseffectivetostudyothercountries'welfaresystemsandalterthesystemstofitanindividualcountry's situationinordertosolvesocialwelfareproblems.
Ⅳ．Concl
usi
on
Thompsondescribedthattheconnectionbetweentheoryandpracticeasbeinga"directparallelbetween thinkinganddoing１）".Bystudyingandcomparingothercountries'welfaresystems,countriescangetanideaof whatsocialsystemsmakethebestexamplesfortheirowncountry.Comparingtheirpoliciestocountrieswith similarbackgroundscanthenbeausefulapproachtosolvingtheirownsocialwelfareproblems.
JapanissimilartoGermany,inthatitisanageingsociety,thusJapanesescholarsstudiedtheGermanLTC asamodeloftheJapaneseLTCI.However,bothcountrieshaveadifferentcultureandhistory.Asaresult,
JapanalteredtheGermanLTC tofittheJapanesecultureandenvironment.Thisisoneexampleofhow a countrymayimplementothercountries'socialwelfaresystemstodealwithpublicdemands.Goodmanand PengarguedthatJapanhasbeenconsideredasan'exception'ofEsping-Andersen'ssocialwelfareregime16）. Japan wasidentified asa'latefemalemobilization welfarestate'and Germany asan 'advanced Christian democraticwelfarestate'３）.Although,GermanyandJapanfallintodistinctwelfaresystem categories,Japan wasstillabletotaketheGermanLTCmodelandapplyittoitsownwelfaresystem.However,Japanmadethe necessarychangestotheLTCsystem inordertofititsowncountry.Thisexampleshowsthatcomparingand contrastingothercountries'policieshelpsusunderstandhow socialtheoriesworkinpracticeandidentifiesthe strengthsandweaknessesofthosetheoriesdevelopedintheoreticalpractice.
Comparingothercountries'policiesprovidesexamplesofwhatanationshoulddoandshouldnotdobasedon other countries'experiences for their own country.Therefore,comparing other countries'socialwelfare systemsisoneeffectivewaytoimplementnew,suitablesocialpoliciesfortheirowncountry.
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