『保健医療科学』 2024 第73巻 第2号 p.118-125（2024年5月）
特集 : 令和 6 年度から始まる厚生労働省の施策
＜総説＞
第 9 期介護保険事業(支援)計画について
森山葉子，柿沼倫弘
国立保健医療科学院 医療・福祉サービス研究部
The Ninth Insured Long-Term Care Service Plans
MORIYAMA Yoko, KAKINUMA Tomohiro
Department of Health and Welfare Services, National institute of Public Health
抄録
国が示す基本指針に基づき，市町村では介護保険事業計画，都道府県では介護保険事業支援計画を，3 年を 1 期として策定することが，介護保険法により定められている. これらは，保険給付の円滑な 実施のために策定され，介護保険事業計画では，種類ごとの介護サービス量の見込みを示し，また介護予防・重度化防止等の取組内容及び目標等を掲げ，これらが介護保険料の設定等につながる. 都道府県には，保険者である市町村の支援が求められており，介護保険事業支援計画の中で，市町村への支援内容及び目標等を掲げることとなっている.
2000 年度より介護保険制度がスタートし，2024 年度からの 3 年間は第 9 期にあたる. この計画期間は団塊の世代が全員 75 歳以上の後期高齢者となる 2025 年を含んでおり，地域包括ケアシステムの構築を始め，2025 年を一つの目途として取り組んできた. 今後は高齢者人口がピークを迎える 2040 年 を見通し，さらなる少子高齢化の進展に向けた対策と，一方で地域により高齢化の進みが大きく異なるなど，より地域の実情に応じた施策を検討していく必要がある.
これら背景を踏まえ，第 9 期における介護保険事業(支援)計画では，大きく 3 つの対応として，1. 介護サービス基盤の計画的な整備，2. 地域包括ケアシステムの深化・推進に向けた取組，3. 地域包括ケアシステムを支える介護人材確保及び介護現場の生産性向上が挙げられた. 地域の実情に応じた介護サービス基盤や，それを支える人材の確保，保険者機能の強化，地域共生社会の実現などに取り組んでいくことが求められている.
また，医療・介護の複合的なニーズを有する高齢者の増加が見込まれ，さらなる医療・介護の連携が重要となる. 2024 年度は第 8 次医療計画もスタートする. 都道府県には地域医療構想を含めた医療計画における在宅医療の整備とともに，地域包括ケアシステムの構築を含めた介護保険事業(支援) 計画による介護サービス量の確保が求められるため，都道府県と市町村の緊密な連携が図られなければならない.
要介護高齢者は増加する一方で，生産年齢人口の急減が見込まれる中，介護保険制度を持続可能な制度として維持するためにも，中長期的な視点で計画を立て，対策を講じていく必要がある.
キーワード：介護保険事業(支援)計画，地域包括ケアシステム，地域共生社会，介護サービス基盤 整備，介護人材確保と生産性向上
Abstract
With regard to Basic Guidelines, municipalities and prefectures are required to provide the Municipal Insured Long-Term Care Service Plan and Prefectural Insured Long-Term Care Service Plan by specifying three years as one term under the Long-Term Care Insurance Act.
These are offered for an efficient implementation of insurance benefits. The Municipal Insured Long-Term Care Service Plan sets out the prospective quantities of service by type covered by long-term care benefits as well as the details of and targets for the initiatives to prevent long-term frailty. The municipality sets the long- term care insurance premium. Prefectures are required to support municipalities as insurers. The content of and goals for support for municipalities must be set forth in a Prefectural Insured Long-Term Care Service Plan.
The long-term care insurance system began in FY2000, and the three-year period starting FY2024 constitutes the ninth period. The plan period includes the year 2025, when all baby boomers will be 75 years of age or older. We have been working on establishing a community-based integrated care system and other initiatives toward 2025. Looking ahead to 2040, when the elderly population is expected to peak, it is necessary to consider measures to address a further decline in the birth rate and population aging, as well as measures that are more tailored to local conditions, such as those to address the substantial regional differences in the aging process.
In light of this, Insured Long-Term Care Service Plans for the ninth period require the following three major responses. 1. Systematic development of a long-term care service infrastructure, 2. Efforts to deepen and promote community-based integrated care system, and 3. Maintain sufficient manpower to support the community-based integrated care system and improving productivity in long-term care. Over the next three years, efforts will be required to build long-term care service infrastructures and the human resources to support them in accordance with local conditions, strengthen the management of long-term care insurance, and realize a community-based inclusive society.
In addition, the number of older adults with complex medical and nursing care needs is expected to increase; hence, cooperation between medical and long-term care services is more important. This is the year in which medical plans are also be formulated, and prefectures are required to ensure the volume of long-term care services through the Insured Long-Term Care Service Plans, including establishing community-based integrated care system and developing home medical care under medical plans, including regional medical plans. Therefore, a close cooperation between prefectures and municipalities must be promoted.
While the number of older adults requiring nursing care is expected to increase, the working-age population is expected to rapidly decline. Therefore, to sustain the system, planning and implementing measures from a medium- to long-term perspective are necessary.
keywords: Insured Long-Term Care Service Plans, community-based integrated care system, communi-ty-based inclusive society, development of long-term care service infrastructure, maintaining sufficient manpower and improving productivity