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In view of the continuing and emerging issues on the current system, it was adequate that the legistrative branch of the government attached the stipulation requiring the review of the system after 5 years to make it more adequate system to be fair and above all as a sustainable system. Nonetheless, it is fair to say that we are still in the "uncharted water" until such time that the care services insurance system is firmly and soundly established with a large consensus of people at large. In this sense, the on-going process of efforts on the part of the U.S. Congress has been trying to amend the current long-term care services policy is worthwhile to look into. The questions raised by the audiences at the symposium have touched on these points as well which will be introduced at later part of this summary more in detail. Also, Dr. Igata's presentation and remarks will be noted in the later part of this summary as well. Presentations and remarks by other delegates are also described in the later part of this summary.

Representing for the United States of America, Mrs. Lupe Wissel, Staff Director for the U.S. Senate's Special Committee on Aging presented her opening remarks in introducing historical perspective of how long-term care services system was introduced based on the Older American Acts and focused on some of the current trends in care services for the elderly in its style and methods both by the Federal and state governments in terms of their policies in conjunction with Medicare and Medicaid, and Social Security Acts. Her detailed comments will be elaborated as follows:

The opening remarks by Mrs.Luppe Wissel are summarized as follows:

"I want to thank the U.S. Foundation for International Economic Policy for inviting me to be part of this very important symposium. Senator Larry Graig, who serves as Chairman of the U. S. Senate Special Committee on Aging, and who is my boss, sends you his best regards. He hopes to someday come to Japan and be part of these important discussions.

I am pleased to be here to discuss and exchange information about the financing and quality-related trends of long-term care in the United States, along with projections of the growth in long-term care needs over the coming decades.

I will begin by describing how we think about long-term care in the United States, discuss current policy and related issues, further trends, and conclude with a description of the evolving consumer choice movement.

Long-term care referees to a wide range of medical, social, personal care and supportive services for people who have lost the capacity for self-care due to chronic illness or frailty. There is a continuum of care in the United States based on living arrangement, medical, and social demands of individuals.

The way we think about care is along the living arrangement continuum. Long-term care services are generally delivered in a single-family homes, multi-family units, assisted living, and nursing homes settings. Single or multiple family units or group residencies are appropriate living arrangements when medical and social services demand is low.

The past decades have been a shift in emphasis away from long-term care provided in nursing home settings to less restrictive homes and community-based care. This shift represents the increasing importance placed on individual dignity and choice.

The United States spent $1.2 trillion or Yen 150 trillion on all personal health care services in 2001. This is equal to about 14% of U.S. national income and that is a lot of money. About $150 billion or Yen 18.8 trillion - or 12 percent of health spending - was spent on long-term care.


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