Creation of the long-term care insurance and its significance for the restructuring of the Japanese welfare state

Abstract

The Japanese Diet passed the Long-term Care Insurance Bill in December 1997. The Long-term Care Insurance Law which creates universal long-term care insurance scheme shall come into force on the 1st of April, 2000.This paper aims to elucidate basic issues that should be examined and to present an analytical framework for sociological analysis of the significance of the creation of the long-term care insurance for the restructuring of the Japanese welfare state.Firstly, policy factors which led to the creation of the long-term care insurance are analyzed in terms of the continuities and changes in the long-term care policies of the Japanese government in the 1980s and the 1990s.Secondly, seven basic characteristics of the institutional design of the newly-created long-term care insurance are examined : universality of benefits, orientation to the national minimum of care service, adequacy of benefit level, financial arrangements, user charge, coordination of medical, health and welfare services, and the roles and functions of profit and non-profit organizations.Finally, social and policy significance of the creation of the long-term care insurance is examined using the theoretical frameworks of (1) the welfare state regime theory developed by G. Esping-Andersen, (2) gender approach to the welfare state typology, and (3) typology of welfare pluralism. Preliminary conclusions of this analysis are (1) that the newly-created scheme will function to maintain and reinforce the conservative nature of the Japanese social security regime, (2) that it will have more or less defamilializing effects in terms of the expansion of formal care services, and (3) that the contrasting nature of the Japanese long-term care insurance scheme and the British community care reform can be clarified by introducing the dual typology of the market-oriented and participation-oriented welfare pluralism, and the service-purchasing type and user-subsidizing type of welfare pluralism.