『保健医療科学』 2023 第72巻 第5号 p.376-386（2023年12月）
特集 : 介護保険における保険者機能強化の現状とこれから
＜総説＞
地域づくりに着目した保険者機能強化をめぐる政策動向
岸英二
厚生労働省老健局認知症施策・地域介護推進課地域づくり推進室
Policy trends in strengthening insurer’s function of long-term care insurance focused on community building
KISHI Eiji
Community-Based Long-Term Care Promotion Office, Division of Dementia Policy and Community-Based Long-Term Care Promotion, Health and Welfare Bureau for the Elderly, Ministry of Health, Labour and Welfare
抄録
団塊の世代が 75 歳以上となる 2025 年を見据え地域包括ケアシステムの構築が進められてきた．2025 年以降，現役世代が減少し医療・介護専門職の確保が困難となる一方で，85 歳以上高齢者は増加していく．また，こうした人口動態や地域資源は地域によって異なる．
高齢者の地域での生活は，医療・介護専門職との関わりのみならず，地域の住民や産業との関わりの中で成立するものであり，高齢者自身も多様な主体の一員となり，地域社会は形作られている．こうした地域のつながりの中で，地域住民の主体的な活動や地域の多様な主体の参入を促進し，医療・介護の専門職がそこに関わり合いながら，高齢者自身が適切に活動を選択できるよう，高齢者が元気なうちから地域社会や医療・介護専門職とつながり，そのつながりのもとで社会活動を続け，介護が必要となっても必要な支援を受けながら，住民一人ひとりが自分らしく暮らし続けられる「地域共生社会」の実現を目指していくことが求められている．
2014 年の介護保険制度改正により現在の形となった介護予防・日常生活支援総合事業を地域づくりの基盤と位置づけ，保険者である市町村が中心となって，医療・介護専門職がより専門性を発揮しつつ，高齢者や多様な主体を含めた地域の力を総動員するという視点に立ち，地域をデザインしながら，その充実を図ることが求められている．
キーワード：地域づくり，介護予防・日常生活支援総合事業，高齢者の選択肢の拡大
Abstract
In anticipation of 2025, when the baby boomer generation will reach the age of 75 or older, efforts have been made to build the community-based integrated care system. After 2025, the number of working people will decrease and it will be difficult to secure medical and nursing care professionals, while the number of people aged 85 years and older will increase. Furthermore, these demographic trends and regional resources differ by region.
The lives of elderly people in the community are enriched not only through their relationships with medical and nursing care professionals, but also with local residents and industry. Society is being shaped as well. Within these community connections, we encourage the independent activities of local residents and the involvement of diverse local actors. While medical and nursing care professionals are involved, elderly people themselves can choose appropriate activities. The elderly can connect with the local community and medical/nursing care professionals while they are still healthy, and continue social activities based on these connections; even when nursing care becomes necessary, each resident can be themselves while receiving the necessary support. There is a need to aim for the realization of a “community coexistence societyʼʼ where people can continue to live.
The care prevention and daily life support project that took its current form due to the revision of the long-term care insurance system in 2014 is positioned as the basis for community development; municipalities, which are insurers, play a central role, and medical and nursing care professionals become more specialized. There is a need to design and enrich the region from the perspective of combining the strengths of the region, including the elderly and diverse actors, while demonstrating the power of the community.
keywords: Community building, Prevention of frailty and Daily Life Support Project, Expanding Options for older people