Model for coordination of community health services and health and welfare services offered by health insurance societies

摘要

The purpose of this paper is to provide information for the development of health and welfare services being offered by health insurance societies (HIS). We analyzed examples of coordinated activities by HISs, the organizations under them (affiliated groups), and regional community self-regulating groups (communities), looking for the shape and direction such coordinated activities should take in the future. We chose 6 cases from public information available from August, 2000 to January, 2001 and visited the parties involved to conduct follow up surveys on the nature of their coordinated activities. Based on a survey conducted by the National Federation of Health Insurance Societies in March, 1999 (Survey of the Current Status of Health and Welfare Services), 36 HISs that were thought likely to be acting in coordination with the community were mailed questionnaires. Of these HISs, 7 that were found to actually be carrying out such coordinated activities were contacted in a telephone survey. We categorized the form and direction of coordinated activities into the following 5 category types: individualized, shared use of facilities, human exchange, shared health management information, and general coordination. The personnel, facilities and institutional capabilities of the affiliated groups are important resources for HISs to carry out health and welfare services, both in general and for coordinated services in the community. In areas where affiliated groups are lacking in resources, communities and other agencies have to actively seek out and make use of external resources. The coordination of services by affiliated groups and the community allows both to make the best use of the capabilities each has and effectively enables them to mutually compensate for their weak points.