保健医療科学

2024

Vol.73 No.1 p.32 − 41

Topics: Recent topics in public health in Japan 2024

＜ Review ＞
Community-based inclusive society and integrated care in Japan:
Concepts and challenges for practice
OTAGA Masaaki
Department of Health and Welfare Services, National Institute of Public Health
Abstract
Since the 1990s, the concept of integrated care has been used to examine methods of care delivery that
ensure quality while increasing efficiency. Japan has developed a service-delivery system that specializes
in independent long-term care through universal public long-term care insurance to respond to the growing care needs of its aging population. This caused a fragmentation of medical care, rehabilitation, andother welfare services, and the concept of community-based integrated care was proposed as an attempt
to integrate these services. As the development of the welfare system for older adults was followed by thedevelopment of support for various target groups such as the needy, children and families, and people withdisabilities, the concept of community-inclusive society was proposed in the context of the need to overcome the vertical system that characterized the welfare system in Japan. This concept of community-based
inclusive society can be explained as including the Japanese concept of integrated care, in which community-based integrated care is provided regardless of the target population, and the concept of community
building, which is promoted through collaboration between “supporters and receivers of care” or “people
and communities”. Efforts to build an integrated support system to achieve community-based inclusive
society have been a policy initiative since FY2016, and the Multilayered Support System Improvement
Project by the municipality has just begun in FY2021. In order to facilitate the building of this system, theproject is expected to identify ways to develop strategies and initiatives in the project that reflect historical,
cultural, and social factors in the region.
keywords: community-based inclusive society, community-based integrated care, integrated care, integrated
support system, Multi-Layered Support System Improvement Project(accepted for publication, January 9, 2024)

I. Introduction
Demographic change in the form of declining birthrates
and aging is a global issue, mainly caused by the rapid increase in the proportion of older adults associated with longer average life expectancy and lower birth rates. The global population is aging rapidly, with the older-adult population
projected to increase from 1 to 2.1 billion between 2019 and2050 [1]. To tackle this problem, health-system reforms areneeded to increase efficiency while ensuring quality, andthe concept of integrated care has been explored since the1990s [2]. The World Health Organization also published aframework for integrated care [3] and guidance on integrated care for older adults [4].
The population of those aged 65 and over in Japan in2023 was 29.1% and is expected to continue increasing,
the highest percentage among countries and regions withpopulations of 100,000 or more [5]. The birthrate has also
not stopped declining, and according to data released by the
Ministry of Internal Affairs and Communications, the per-Corresponding author: OTAGA Masaaki
2-3-6 Minami, Wako, Saitama 351-0197, Japan.
Tel: 048-458-6141
Fax: 048-458-6177
E-mail: otaga.m.aa@niph.go.jp

32

J. Natl. Inst. Public Health, 73 (1) : 2024

Community-based inclusive society and integrated care in Japan
centage of the population under 15 years old in Japanʼs total
population as of 2023 is 11.5%, a 49-year continuous decline[6].
As a front runner in the aging society with a declining
birthrate, Japan has been fast in responding to the growingcare needs of its older adults. Three years after the longterm-care insurance system was enacted in FY2000, theneed for community-based integrated care was describedin a national report, and policies have been developed since2006 to actualize this concept. After 2015, in the process ofextending the community-based integrated care approachin long-term care insurance to other welfare services,
guidelines for a new welfare system were presented, andthe concept of a community-based inclusive society was
proposed. in FY2016, the reform process toward its actualization was presented, and from FY2021, the project toestablish a multi-layered support system was established asa policy to promote an integrated support system to achieve
a community-based inclusive society.
This paper introduces the background of the Japanese
governmentʼs proposal of this community-based inclusive
society and clarifies this concept through a comparison withthe community-based integrated-care system. This paper
also focuses on the Multi-Layered Support System Improvement Project for actualizing this concept and discusses the issues with this project.

II. Background of proposing concept of community-based inclusive Society
1. Characteristics of Japanese welfare system
As shown in Table 1, Japanʼs welfare system was developed during the period of rapid economic growth afterWorld War II and has evolved into several sub-systems bytarget group, including older adults, the needy, children
and families, and persons with disabilities. By emphasizing
benefits for the target population, the welfare system has
provided little support regarding the informal care provided
by family members and community residents. Thus, thesystem is unable to regulate support that takes into accountthe circumstances of all people, so the support for people
not covered by the system could be said to depend on informal support. While demographic changes, such as fallingbirthrate and aging population, have led to an increase in

Table 1 Chronology of establishment of major welfare sub-systems by target group
Needy person
1940–1959

Child and Family
1947 Child Welfare Act

1950 Public Assistance Act

1960–1979

Person with a disability

1964 Act on Welfare of Motherswith Dependents and Widows(Establishment of support measures for single-parent families)

1963 Act on Social Welfare for the
Elderly

1980–1999
1995 Act on Mental Health andWelfare for the Mentally Disabled
1999 Act for the Welfare of Persons
with Intellectual Disabilities
2000–20092006 Services and support for
Persons with Disabilities Act(Unification of services previously
divided by type of disability
2010–2015 Act on Self-Reliance Support
for Needy Persons(Establishment of support forneedy people without income
regulations)2022 Revision of the Act on
Self-Reliance Support for Needy
Persons (Establishment of community building project)

2015 Child and Child Care Support
Act(Establishing community childcare
support project)

Older adult1947 Act for the Welfare of Persons
with Physical Disabilities
1950 Old Act on Mental Health andWelfare for the Mentally Disabled1951 Old Act for the Welfare of
Persons with Intellectual Disabilities

2013 Act on Providing Comprehensive Support for the Daily Lifeand Life in Society of Persons with
Disabilities (Addition of patientswith diseases for which treatment
methods have not been established)

J. Natl. Inst. Public Health, 73 (1) : 2024

1982 Health and Medical Service
Act for the Aged2000 Long-Term Care Insurance
Act
2006 Revision of the Long-TermCare Insurance Act(Establishment of community
support projects)

2015 Revision of the Long-TermCare Insurance Act(Enhancement of community
support projects)

33

OTAGA Masaaki
care needs, they have also produced changes such as family
diversification and individualism, and government censuseshave revealed that the community ties that supported informal care have weakened as a result [7].
One major change in the welfare system as an adaptation
measure was the introduction in FY2000 of a mandatory
public long-term-care insurance system that promoted thesocialization of care and marketization of service provision.
The trend is returning to an emphasis on the role of local
governments, mutual aid by community residents, and volunteer activities of community residents. This movement iscalled “(re) regionalization” and has become a characteristicof Japanʼs recent welfare system [8]. Tsutsui also explains
this trend in terms of three phases: care by family, care bysociety, and care by community [9]. This regionalization
promoted by the long-term-care insurance system has also
been applied to other areas of the welfare system. Specifically, community support by municipalities was introduced
for the disabled in FY2006, for families raising children in
FY2015, and for the needy in FY2022.
With the increasing number of dual-earner households
and the growing number of older adults requiring more
support for childcare and long-term care than ever before,
the content and quantity of welfare services stipulated by
uniform national standards as benefits by target group havebeen developed. since the supply of services could not be
met with uniform benefits at the national level, community-support projects were designed to be undertaken at
the discretion of municipalities according to local conditions. However, the increasing number of single-personhouseholds and the shift to nuclear families, as well as theincreasing concentration of population in cities and growing
number of people living in housing complexes, have led
to the weakening of ties among local residents, which has
caused challenges in promoting community-based initia-

tives. In response to this situation, a policy paper entitled“Vision for the Provision of Welfare in a New Era” was released in September 2015, proposing reforms to the welfare
system to overcome social challenges [10].
2. Three social challenges to welfare system identified in 2015 policy paper(1) Emergence of people who need to coordinate
services spanning multiple areas
With advances in the progress of medical science andother factors, the numbers of older adults, persons with disabilities, and children living in the community while receiving healthcare have increased, and the need for welfare services to support the lives of these individuals have grownaccordingly. Community living for those in need of carerequires not only long-term care but also housing arrangements as a prerequisite for living, support for self-reliant
living, and medical care, nursing care, and rehabilitation byprofessionals as needed. Care recipients and their families
also need psychological support as they have various anxieties [11]. To provide such support, coordination of services
across multiple areas is necessary.
As shown in Table 2, however, it is clear from the survey
data of those eligible for consultation support provided under the Self-Reliance Support System for the Needy thatstarted in FY2015 that many in need have two or more difficulties in their lives [12]. When dealing with such multiple
difficulties, it is necessary to coordinate services acrossmultiple systems.
To address such concerns, it is important to achieve asense of unity from the userʼs point of view, in which theuser feels that a variety of services and support are provided by a unified team, even if they are provided by multiple
providers and professionals. However, actual services andsupport are generally provided by a variety of corporations,

Table 2 Types and number of difficulties faced by new consultants who used welfare system forsupporting self-reliance of the needy [12]Type of difficulties（Multiple answers）％

Number of difficulties％

Economic hardship46.4

5 or more

16.2

Difficulty in finding a job

23.6

4

10.4

Illness

20.6

3

14.9

Family problems

17.4

2

16.9

Housing instability

15.9

1

14.9

Mental health problems

15.1

No specifics, unknown

26.8

Household financial management challenges

12.4

Employment retention difficulties

11.4

Multiple debts/Over-indebtedness

11.3

Homelessness

7.2

Other

7.1

No specifics, unknown

26.8

Note: N=106,422, The top ten difficulties are described.

34

J. Natl. Inst. Public Health, 73 (1) : 2024

Community-based inclusive society and integrated care in Japan
organizations, and businesses, and in many cases, users end
up having to deal with multiple providers individually. In response to these issues, it is necessary to regain the capacity
to support the entire community. At the same time, a situation has arisen in which providing consultation and support
by target group, as has been the case in the past, does notalways result in sufficient consultation and support. It waspointed out that the existing specialized and vertically segmented welfare system has made it increasingly difficult todeal with households that are currently facing life issues
and complex difficulties not covered by the system, andthat it is necessary to make it possible to provide integrated
consultation and support, regardless of the area, in accordance with the situation of the target group [10].

fare services to meet increasingly complex support needs,
and more effort will be needed to secure welfare personnel than ever before. However, due to the rapid decline inbirthrates and the aging of the population, Japanʼs overalllabor force continues to decline, and various sectors, notjust welfare, are suffering from labor shortages due to theirinability to secure the necessary human resources. Given
this gap between demand (support needs) and supply (welfare personnel), it is expected to become even more difficult to dramatically increase the number of personnel in thewelfare sector, which is still suffering from a labor shortage.
Therefore, it was pointed out that to make welfare services
sustainable in a society with a declining population, it isnecessary to study effective and efficient service delivery
systems and study the use of human resources in the welfare sector, including how careers should be organized [10].

(2) Necessity of an effective service delivery system in response to the shortage of workforce
According to estimates for 2023 [13], the aging rate is
expected to increase until 2042, and the number of people
requiring long-term care will continue to increase (Table 3).
More welfare personnel will also be needed to enhance welTable 3(3) Necessity to achieve an inclusive society that
responds to diversity of community
In a welfare state that pursues the well-being of its
people, an inclusive society is expected where all people,

Population trends by age group in Japan [13]year

Population(thousand)

0–14

15–64

65–

1950

83,200

35.4

59.7

4.9

1955

89,276

33.4

61.3

5.3

1960

93,419

30

64.2

5.7

1965

98,275

25.6

68.1

6.3

1970

103,720

23.9

69

7.1

1975

111,940

24.3

67.7

7.9

1980

117,060

23.5

67.4

9.1

1985

121,049

21.5

68.2

10.3
12.1

1990

123,611

18.2

69.7

1995

125,570

16

69.5

14.6

2000

126,926

14.6

68.1

17.4
20.2

2005

127,768

13.8

66.1

2010

128,057

13.1

63.8

23

2015

127,095

12.5

60.8

26.6

2020

126,146

11.9

59.5

28.6

2025

123,262

11.1

59.3

29.6

2030

120,116

10.3

58.9

30.8

2035

116,639

10

57.6

32.3

2040

112,837

10.1

55.1

34.8

2045

108,801

10.1

53.6

36.3

2050

104,686

9.9

52.9

37.1

2055

100,508

9.6

52.8

37.6

2060

96,148

9.3

52.8

37.9

2065

91,587

9.1

52.5

38.4

2070

86,996

9.2

52.1

38.7

Data Source：National Institute of Population and Social Security Research.
Population Projections for Japan: 2021-2070, 2023
Note: Values after 2025 are estimates.

J. Natl. Inst. Public Health, 73 (1) : 2024

35

OTAGA Masaaki
including the older adults, people with disabilities, children,and the needy, who are the target of welfare services, canlive harmoniously in the community regardless of theirgeneration or background. Depending on the region, thesituation that will be faced in the future will differ greatly,for example, the young population will decrease while theolder-adult population will increase, or the decrease in theyoung population will further accelerate and the older-adult
population will also decrease. In each region, it is importantto take these circumstances into account and proactively
consider how the necessary welfare-service delivery system should be while considering future changes in welfare
needs. For this reason, it is necessary to establish a service-provision system by diverse entities that can respondto future changes in support needs in the community andenable the provision of welfare services that the community
considers appropriate in light of its circumstances, whileaiming to achieve an inclusive society in which everyone issupported [10].
3. Four reforms of the welfare system proposed in2015 policy paper
The 2015 policy paper proposed four reforms to overcome the three social challenges described above. First, the
new community-based integrated support system includes:“1. An integrated consultation and support system that is
implemented through a one-stop consultation service or
through collaboration among agencies,” and “2. An integrated service-provision system for older adults, the disabled, children, and the needy through the development of

Figure 136

multi-generational exchange and multi-functional centers
for welfare and community building”.
Regarding the environment that supports this system,
the committee then proposed “3. Providing effective services by using advanced technologies such as robots or ICT[information and communication technology] and assessing
the quality of services” and “4. Human resource development for integrated support systems”. These reform proposals are the basis for the concept of a community-based
inclusive society.

III. Characteristics of concept of community-based inclusive society and responses
toward its implementation
The Plan for Promoting Dynamic Engagement of All
Citizens [14] introduced in 2016 presents the concept of acommunity-based inclusive society, a society in which all
people, including children, older adults, and people withdisabilities, can create and enhance their communities,
lifestyles, and purpose in life together. It also states thatthe actualization of this concept requires a system that does
not divide people into supporters and recipients but rather
enables all community residents to have roles and support
each other and cultivate local communities where they canbe active in their roles while helping each other in cooperation with local public services such as welfare.
The current definition of community-based inclusive society offered by the Ministry of Health, Labour and Welfare,however, is “a society that transcends the vertical divisions

Ministry of Health, Labour and Welfareʼs image of community-based inclusive society [15]J. Natl. Inst. Public Health, 73 (1) : 2024

Community-based inclusive society and integrated care in Japanin each system and area, and the relationship of supporterand recipient, and creates a life and motivation for living foreach resident and the community together through the participation of local residents and diverse local entities, andby linking people to people and people to resources beyond
generations and areas” [15]. Along with this definition, theMinistry of Health, Labour and Welfare provides the image
shown in Figure 1.
From the above definition, a community-based inclusive
society has a component of community building, in whichpeople and communities co-design and co-produce, and Ehrenberg et al. [16] describe this new approach as integrated
community care. Harada [17] also focused on the collaborative relationship between supporters and recipients and explains it in terms of the concept of caring community. Since
the definition also includes information on the use of local
public services such as welfare, it can be said that an integrated system for providing these services is also included
in its components. Harada [17] organizes the integrated
support system for achieving a community-based inclusive
society and community-based integrated care system forolder adults as a higher-level concept that also extends toother target groups.
The Ministry of Health, Labour and Welfare defines thissystem as “a community-based integrated care system thatprovides integrated support and services to enable older
adults to continue living their own life to the end of theirlives in their familiar community as long as possible, withthe objective of preserving their dignity and supporting
independent living.” [18]. In other words, it is an integrated
community system for providing support and services incommon, thus does not specify the target group. Tsutsui [19]points out that the unique characteristic of Japanʼs community-based integrated care system is that it encompasses

the two concepts of community-based care and integrated
care, and the integrated support system to achieve a community-based inclusive society can be categorized as aJapanese-style integrated care concept with the same characteristics.
In 2017, the Social Welfare Law was revised to reflect
the concept of a community-based inclusive society, which
includes “ensuring that community residents have opportunities to lead their daily lives as members of the communityand participate in social, economic, cultural, and all otherfields of activities” and “identifying and resolving difficulties in community life through cooperation among relevant
parties. The responsibilities of community residents, professionals and institutions involved in support, and municipalities to work together were clarified [20].

IV. Promotion of building integrated support
system and establishment of multi-layered
support-system-improvement projectIn 2019, a study group of experts was convened to discuss measures to promote the nationwide building of an
integrated support system in municipalities, and recommendations were compiled to promote the building of an
integrated support system in municipalities to meet theincreasingly complex and complicated support needs ofcommunity residents [21]. In response to these recommendations, the Multi-Layered Support System Improvement
Project was established in April 2021. In order to apply forthis project and be eligible for a government grant, it isa prerequisite to implement the Integrated Consultation
Support Project, the Participation Support Project, and theCommunity Building Support Project. The reason for this isthat these three are envisioned as the core of the integrat-

Table 4 Five projects comprising the Multi-Layered Support System Improvement Project [22]Project name
Integrated Consultation Support projectContent to be implemented･Integrated consultation regardless of demographics or generation･Provide support by using the network among support organizations･Connect complex and compounded issues to multi-agency collaborative projects when appropriate
Participation Support Project･Provide support for building connections with society･Enable Matchmaking based on the needs of clients and planning of activity content･Provide support to clients for job retention and finding employment
Community Building Support Project･Develop places and gathering places where people can interact across generations and demographics･Coordinate individual activities and people to create opportunities for exchange, participation,and learning
・Forming local platforms and activating activities in the community
Outreach-based Continuous Support Project ･Reach out to those who are not receiving support･Identify potential consultants through meetings and networking with related organizations･Focus on support for building trusting relationships with clients
Multi-agency Collaboration Project･Establish an integrated consultation and support system for the entire municipality･Play a central role in the multi-layered support-system-improvement project･Promote shared roles among support organizations

J. Natl. Inst. Public Health, 73 (1) : 2024

37

OTAGA Masaaki
ed support system, which is also being verified through apilot project from 2016 to 2020. However, this requirement
is one of the reasons this project has not progressed. Thisis because, even without implementing all three projects,
the local resources and systems of the municipality would
allow for the integrated consultation system, integrated
community building, and promotion of social participationof community residents that are intended to be achieved
through these projects. Moreover, “Continuous Support
Project through Outreach” and “Multi-Agency Collaboration
Project” are also included in this project content, and theseare optional. The content to be implemented in each projectis shown in Table 4.
Financial support from the national and prefectural governments to municipalities in the Multi-Layered Support
System Improvement Project will be granted in a package,
including financial resources from existing systems. This is
expected to promote team support by related organizations.
Municipalities are required to formulate an implementation
plan for appropriate and effective implementation of the
project. Through this plan, municipalities are required to
exchange opinions with residents, related persons, and related organizations and foster a common understanding of
the principles of the project implementation and direction it
should take.
There are 189 municipalities that plan to implement the
project in FY2023, and 280 municipalities that are preparing
for the transition [23]. The effectiveness of the Multi-Layered Support System Improvement Project must be verified
through comparison of municipalities that have implemented the project with those that have not yet implemented
the project, but the methodology for this is still being explored. According to previous studies, evaluating integrated
care is not simple, and while evidence is emerging that the
project has been effective in reducing unnecessary services
and improving the quality of services, there are few studies
demonstrating its cost-effectiveness [24].
For the community-based integrated care system, whichis the leading integrated care system in Japan, there is a
sub-system to evaluate the efforts of municipalities at thenational level and provide financial incentives in accordancewith the results, but no evidence has been presented on
the outcomes and cost effectiveness of this system. Thus,an analysis of a national-level database should be conducted[25].
When devising the evaluation of a multi-layered support
system, there is no national-level database that indicatesthe quality of life, mental and physical condition, and social
status of the people receiving support. There are also many
entities involved in the project, making it difficult to identify which type of support affected the projectʼs effective-

38

ness. Therefore, it is more important to develop strategies
based on specific historical, cultural, and social factors andto evaluate what changes have occurred in the supporters
and the support process as a result of efforts based on thesestrategies, rather than to identify changes in those whohave received support for a specific intervention. Hirano[26] refers to such attempts as evaluative thinking, which
is a necessary skill for municipal officials who promote
multi-layered support-system development.
Municipalities, which are responsible for the administration of long-term-care insurance, are expected to be
the main actors in building a community-based integrated
care system, but they will also have a significant role in thebuilding of an integrated support system. The populationof the 1,741 municipalities in Japan varies widely, and regional disparities are widening. To reduce this disparity, it
is necessary to visualize initiatives through evaluation andsupport municipalities through the national government andprefectures.

V. Conclusion
Japanʼs declining birthrate and aging population are
expected to continue, and the population is expected to
decline. The Japanese approach to integrated care that isbeing promoted in this context is characterized by its community-based approach, starting with community-based
integrated care that mainly targets older adults, and is being
extended to a community-based inclusive society that does
not specify the target group. Initiatives to establish integrated support systems and multi-layered support systems
to achieve such a community-based inclusive society are
underway. These initiatives are led by municipalities, but
their regional resources differ greatly. In order to reduce
the predicted regional disparities in the future, evaluation
methods for the initiatives and ways to support the municipalities will be needed.

Acknowledgments
This study was supported by a Health, Labour and Welfare Sciences Research Grant from the Japanese MHLW
(grant 23AA2002).

Conflicts of Interest
The author declares no conflicts of interest regarding the
publication of this article.

J. Natl. Inst. Public Health, 73 (1) : 2024

Community-based inclusive society and integrated care in Japan

References[1] World Health Organization. Ageing. Geneva: World
Health Organization; 2021. https://www.who.int/
health-topics/ageing#tab=tab_1 (accessed 2024-01-09)[2] Kodner D. All together now: a conceptual exploration of
integrated care. Healthcare Quarterly. 2009 Oct;13(Spec.
No.):6–15.
[3] World Health Organization. Framework on integrated,people-centred health services. 2016. http://apps.who.int/
gb/ebwha/pdf_files/WHA69/A69_39-en.pdf?ua (accessed2024-01-09)[4] World Health Organization. Guidance on person-centred
assessment and pathways in primary care. Handbook.
Geneva: World Health Organization; 2019. https://apps.
who.int/iris/bitstream/handle/10665/326843/WHO-FWCALC-19.1-eng.pdf?sequence=17&isAllowed=y (accessed 2024-01-09)[5] 総務省．統計からみた我が国の高齢者（令和 5 年 9 月
17 日）．2023.
Ministry of Internal Affairs and Communications. [Tokei
kara mita wagakuni no koreisha (Reiwa 5 nen 9 gatsu 17
nichi).] 2023. https://www.stat.go.jp/data/topics/pdf/topics138.pdf (in Japanese)(accessed 2024-01-09)[6] 総務省．我が国のこどもの数（令和５年 5 月 4 日）．
2023.
Ministry of Internal Affairs and Communications. [Wagakuni no kodomo no kazu. (Reiwa 5 nen 5 gatsu 4 nichi).]2023. https://www.stat.go.jp/data/jinsui/topics/pdf/topics137.pdf (in Japanese)(accessed 2024-01-09)[7] 内閣府．
「絆」と社会サービスに関する調査．
Cabinet Office. [“Kizuna” to shakai service ni kansuru
chosa.] 2014. (in Japanese)[8] Miyazawa H. Welfare regime in Japan and recent social
security reform. In: Miyazawa H, Hatakeyama T. editors.
Community-based integrated care and the inclusive society. Singapore: Springer; 2021. p.3–17.
[9] Tsutsui T. Implementation process and challenges forthe community-based integrated care system in Japan.
International Journal of Integrated Care. 2014(14). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905786/pdf/
IJIC-14-2014002.pdf (accessed 2024-01-09)[10] 厚生労働省．誰もが支え合う地域の構築に向けた福祉サービスの実現̶新たな時代に対応した福祉の提供ビジョン̶（平成 27 年９月 17 日）．2015.
Ministry of Health, Labour and Welfare. [Daremoga
sasaeau chiiki no kochiku ni muketa fukushi service nojitsugen: Aratana jidai ni taio shita fukushi no teikyo vision (Heisei 27 nen 9 gatsu 17 nichi).] 2015. https://www.
mhlw.go.jp/file/05-Shingikai-12201000-Shakaiengokyokushougaihokenfukushibu-Kikakuka/bijon.pdf (in Japa-

nese)(accessed 2024-01-09)[11] 三菱UFJリサーチ&コンサルティング株式会社．地域
包括ケアシステムと地域マネジメント．地域包括ケ
アシステム構築に向けた制度及びサービスのあり方に関する研究事業．平成 27 年度厚生労働省老人保健事業推進費等補助金老人保健健康増進等事業．
Mitsubishi UFJ Research and Consulting Co., Ltd. [Chiiki
hokatsu care system to chiiki management. Chiiki hokatsu care system kochiku ni muketa seido oyobi service noarikata ni kansuru chosa kenkyu jigyo. Heisei 27 nendo
kosei rodosho rojin hoken jigyo suishinhi to hojokin rojin
hoken kenko zoshin to jigyo.] 2016. https://www.murc.jp/
wp-content/uploads/2022/11/koukai_160509_c1.pdf (inJapanese)(accessed 2024-01-09)[12] みずほ情報総研株式会社．生活困窮者自立支援制度の相談機関における支援実績の分析による支援手法
向上に向けた調査研究事業報告書．平成 28 年度生活困窮者就労準備支援事業費等補助金（社会福祉推進
事業）（平成 29 年 3 月）．2017.
Mizuho Information & Research Institute, Inc. [Seikatsu
konkyusha jiritsu shien seido no sodan kikan ni okeru
shien jisseki no bunseki ni yoru shien shuho kojo ni
muketa chosa kenkyu jigyo hokokusho. Heisei 28 nendo
seikatsu konkyusha shuro junbi shien jigyohi hojokin(shakai fukushi suishin jigyo)(heisei 29 nen 3 gatsu)]
2017. (in Japanese)[13] 国立社会保障・人口問題研究所．日本の将来推計人
口（令和 5 年推計）
．2023.
National Institute of Population and Social Security
Research. [Nihon no shorai suikei jinko (Reiwa 5 nensuikei).] 2023. https://www.ipss.go.jp/pp-zenkoku/j/zenkoku2023/pp_zenkoku2023.asp (in Japanese)(accessed2024-01-09)[14] 内閣府．ニッポン一億総活躍プラン（平成 28 年 6 月
2 日閣議決定）．
Cabinet Office. [The plan for promoting dynamic engagement of all citizens (Heisei 28 nen 6 gatsu 2 nichi kakugi
kettei).] 2016. (in Japanese)[15] 厚生労働省ホームページ．地域共生社会のポータル
サイト．
Ministry of Health, Labour and Welfare. [Chiiki kyosei
shakai no portal site.] https://www.mhlw.go.jp/kyouseisyakaiportal/ (in Japanese)(accessed 2024-01-09)[16] Ehrenberg N, Vandenbroeck P, Sørensen M, Vandensande
T. Integrated community care: A community-driven, integrated approach to care. In: Amelung V, Stein V, Goodwin
N, Balicer R, Nolte E, et al, editors. Handbook integrated
care. Cham, Switzerland: Springer International Publishing; 2021. p.105-118.
[17] 原田正樹．地域包括ケアシステムの深化としての包括的支援体制̶病院に期待される役割̶．病院．

J. Natl. Inst. Public Health, 73 (1) : 2024

39

OTAGA Masaaki
2022;81(3):207-211.
Harada M. [Chiiki hokatsu care system no shinka to shite
no hokatsuteki shien taisei: Byoin ni kitai sareru yakuwari.] Byoin. 2022;81(3):207-211. (in Japanese)[18] 厚生労働省ホームページ．地域包括ケアシステム．
Ministry of Health, Labour and Welfare Homepage.
[Chiiki hokatsu care system.] https://www.mhlw.go.jp/stf/
seisakunitsuite/bunya/hukushi_kaigo/kaigo_koureisha/chiiki-houkatsu/ (in Japanese)(accessed 2024-01-09)[19] 筒井孝子．地域包括ケアシステム構築のためのマネ
ジメント戦略：integrated careの理論とその応用．東京：中央法規； 2014．
Tsutsui T. [Chiiki hokatsu care system kochiku no tameno management senryaku: integrated cate riron to sonooyo.] Tokyo: Chuo Hoki; 2014. (in Japanese)[20] 衆議院．地域包括ケアシステムの強化のための介護保険法等の一部を改正する法律．
The House of Pepresentatives, Japan. [Chiki hokatsu caresystem no kyoka no tameno kaigo hokenho to no ichibuo kaisei suru horitsu.] https://www.shugiin.go.jp/internet/
itdb_housei.nsf/html/housei/19320170602052.htm (in Japanese)(accessed 2024-01-09)[21] 厚生労働省．
「地域共生社会に向けた包括的支援と多様な参加・協働の推進に関する検討会（地域共生社
会推進検討会）」最終とりまとめ．
Ministry of Health, Labour and Welfare. [Chiiki kyosei
shakai ni muketa hokatsu teki shien to tayo na sanka /kyodo no suishin ni kansuru kentokai (chiiki kyosei shakaisuishin kentokai) saishu torimatome.] 2019. https://www.
mhlw.go.jp/content/12602000/000581294.pdf (in Japanese)(accessed 2024-01-09)40[22] 厚生労働省ホームページ．重層的支援体制整備事業について，地域共生社会のポータルサイト．
Ministry of Health, Labour and Welfare Homepage.
[Jusoteki shien taisei seibi jigyo ni tsuite, Chiiki kyosei
shakai no portal site.] https://www.mhlw.go.jp/kyouseisyakaiportal/jigyou/ (in Japanese)(accessed 2024-01-09)[23] 厚生労働省ホームページ．地域共生社会・重層事業に関する取組事例・広報．
Ministry of Health, Labour and Welfare Homepage. [Chiiki kyosei shakai / juso jigyo ni kansuru torikumi jirei /koho.] https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/
hukushi_kaigo/seikatsuhogo/chiikikyosei/index_00005.
html (in Japanese)(accessed 2024-01-09)[24] 筒井孝子，大夛賀政昭．介護保険制度における保険者機能の評価の考え方と課題．保健医療科学．
2023;72(5):395-409.
Tsutsui T, Otaga M. [Evaluation of initiatives by municipalities as insurers of long-term care insurance: Concepts,
issues, and applications.] Journal of the National Instituteof Public Health. 2023;72(5):395-409. (in Japanese)[25] Hughes G, Shaw SE, Greenhalgh T. Rethinking integrated care: a systematic hermeneutic review of the literature
on integrated care strategies and concepts. The Milbank
Quarterly. 2020;98(2):446-492.
[26] 平野隆之．地域福祉マネジメントと評価的思考−重層的支援体制整備の方法．東京：有斐閣； 2023．
Hirano T. [Managing community welfare and facilitating
evaluative thinking: Methods of instituting multi-layered
support systems at the municipal level.] Tokyo: Yuhikaku;
2023. (in Japanese)

J. Natl. Inst. Public Health, 73 (1) : 2024

Community-based inclusive society and integrated care in Japan＜総説＞
日本における地域共生社会と地域包括ケア―概念と実践に向けた課題―
大夛賀政昭
国立保健医療科学院医療・福祉サービス研究部

抄録
少子高齢化という人口動態の変化はグローバルな課題であり，これに対応したヘルスシステムの変
革が求められている．1990 年代から統合ケアという概念によって，質を確保しながらその効率性を高めていくケアの提供手法について検討されてきた．日本は，高齢化の進展に伴い増大するケアニー
ズに対応するために介護保険制度を創設し，介護サービスに特化した提供システムを整えてきた．これによって，医療やリハビリテーション，その他福祉サービスとの断絶が起こったため，その統合にむけ「地域包括ケア」という概念が提唱され，この実現に向けた取り組みが継続的に実施されてきた．
その後，高齢者福祉領域で実施されてきたこれらの試みを他の領域（生活困窮者，子ども家庭，障害を持つ人など）の支援へと展開し，その充実を図る過程において，縦割りの制度の克服や地域づくりが求められ，「地域共生社会」という概念が提案された．この概念は，世代や分野を問わず地域を基盤として包括的にケアを提供していくという日本型の統合ケアの概念と，ケアの支え手と受け手や人々と地域の共同性を推進する地域づくりの概念という 2 つの概念を内包するものと説明できる．この地域共生社会を実現するための包括的支援体制の構築に向けた政策は 2016 年度以降実施されてきており，2021 年度より市町村による重層的支援体制整備事業も創設された．現在，これらの取り組
みを地域の実情に応じて推進していくための，戦略の立て方を含む方法論の確立が求められている．
キーワード：地域共生社会，地域包括ケア，統合ケア，包括的支援体制，重層的支援体制整備事業

J. Natl. Inst. Public Health, 73 (1) : 2024

41