18 中長期的な社会保障改革の骨太方針（目指すべきビジョンや哲学を含む）を検討・策定等するため、関係大臣、有識者、関係者代表（被用者、病院、患者団体、業界団体を含む）から構成される「社会保障版・諮問会議」（仮称）を設置する。その下部組織として、年金、医療、介護等の分野ごとの部会、ビックデータを利用して分析を行う専門組織を設置し、委員(任期4年)を支援するスタッフを配置し、関係省庁からのデータ収集やヒアリングの権限を付与する。 A ‘Social Security Advisory Council’ made up of relevant ministers and experts with all key stakeholders (including health system users, hospitals, patient groups, industry) should be established for discussing medium-to-long-term social security and drafting a comprehensive ‘honebuto’, with a vision and philosophy, for reform. Attached to that council, there should be expert working groups established to conduct analysis using big data on pensions, health services, caregiving and other areas. Members of this experts’ group would have a term of 4-5 years, and be provided with support staff, and have authority to obtain data from relevant government organs and conduct hearings as required.■ 現状の問題点・将来予測やデータ分析に基づいた改革議論が少ない。・パッチワーク的で部分最適な改革議論が多く、全体最適の改革議論が欠如。・「何を諦め、何を守るのか」という哲学が明確ではない。・社会保障制度は極めて複雑であり、システム全体へのインパクトを考慮しながら改革を行わなければ、持続的な制度が構築できず、患者など関係者やシステムに予想外の損害が起きかねない。■ Current Issues・ Little of the debate on social security reforms is based on long-term forecasts or data analysis. ・ Most of the debate on reform is ‘patchwork’ and will only lead to partial optimization—debate on reforms that will lead to full optimization is absent.・ The logic behind what services or benets should be renegotiated, and what should be protected, is not clear in current debates.・ Given the complexity of the social security system, making changes without considering their impact to the system as a whole risks failure to achieve sustainable social security, and may unintentionally do harm to patients or the system in the process.■ 目指すべき方向性・会議においては、まず、目指すべきビジョンや改革の哲学をしっかり構築し、その後、中長期的な社会保障改革の骨太方針を議論する（例：リスク分散機能を担う保険と再分配機能を担う税との切り分け、税は本当に困っている人々に集中投下、現物給付（住宅・食料）の再考と空き家の活用）。・専門組織を活用し、エビデンスに基づく議論を行う（例：年金の将来分布を予測し、生活扶助やマクロ経済スライドとの関係を含め、本当に困っている人々（女性の貧困高齢者の急増への対応など）をしっかり守る。・改革の予見性や透明性を高める（例：産業競争力や投資の視点、医療版マクロ経済スライドの導入）。■ Recommended Directions・ First establish a vision and philosophy to be used by the council for discussion of a ‘honebuto’ for mid-to-long-term social security reform (e.g. clarify the distinction between insurance, which functions as risk diffusion, and tax, for redistribution, and use tax for those in genuine need; reconsider in-kind benefits (housing/food); and discuss how to utilize vacant housing).・ Use this expert forum for evidence-based debate (e.g. forecast future pension distributions and use these to design assistance benets, a macro-economic slide or other measures to support individuals in genuine need). ・ Increase the predictability and transparency of system reforms (e.g. consider impacts on industry competition and investment, or introducing a heath version of the macro-economic slide for pensions). 提言 10Proposal 10国民的議論の展開Contribute to national debate on social security issues
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