Abstract
Background: Japan's social welfare system has been developed according to the nature of the people covered by the system, such as the economically needy, people in need of physical assistance, older adults, and children and families with special care needs. While this feature has allowed for a more specialized and individualized approach, its complexity has been a challenge in terms of both system operation and utilization. As one of the fastest aging countries in the world, Japan has also responded to the growing need for medical care and long-term care by reforming its service delivery system based on the concept of a community-based integrated care system, which has been integrated in the healthcare system since 2006. Since 205, Japan has been working to adapt the experience of reforms in the health care system to social care under the vision of a community-based inclusive society. Specifically, through the implementation of pilot projects to promote integration among welfare systems with regard to the three themes of consultation, social participation, and community building, a system was introduced from 202 called the Multilayered Support System Improvement Project (MSSIP), which allows for the integrated provision of initiatives that had been implemented separately for each target population at the discretion of municipalities.
Approach: An online questionnaire was distributed to 32 municipalities where research committee members are involved in the project during spring 2024. The survey set up questions to assess the level of integration between MSSIP and the counseling and community building agencies established in the four population groups (older adult, person with disability, child and family, and needy person). For the assessment of the level of integration, a five-point scale from 0 to 4 was used, based on Ahgren B and Axellson R's framework of the continuum of integrated care (Full segregation, Linkage, Co-ordination, Co-operation, Full integration). Data from 28 municipalities with no missing values were used in the analysis.
Results: The levels of integration in the counseling agencies for each of the four population groups were: older adult 2.57, person with disability 2.68, child and family 2.64, and needy person 3.. And the levels of integration in the community building agencies were: older adult 2.7, person with disability ., child and family 0.96, and needy person .79.
Implications: Integration of care is often discussed between health care and social care, but depending on the design of the social welfare system, it is also necessary for each social care population group. In this study, we attempted to apply an evaluation framework for the level of integration, and differences in integration efforts by population group were visualized. This information will be useful in advancing efforts in social care where integration is less advanced.