Abstract
The Japanese population is rapidly aging. The proportion of people aged ≥65 was 27.3% in 2016, the highest in the world. Japan achieved universal health coverage for medical care in 1961 with the introduction of the National Health Insurance (NHI) system. However, increasing expenditure on inpatient care for old people became a significant issue in society. At that time, tax-supported in-home services were mainly for old people with low incomes and little care given by family. To tackle these problems, universal health coverage for long-term care was introduced in 2000 under the Long-Term Care Insurance (LTCI) system. People aged ≥65 who satisfied the eligibility criteria and those aged 40–64 with age-related diseases are entitled to receive long-term care services at home or in facilities, irrespective of income level and availability of family caregiving. The practical benefits in kind under the LTCI system for family caregivers have been demonstrated. However, because of a recent increase in long-term care costs, especially facility-based costs, it may be necessary to give more support to family (informal) caregivers who participate in home-based long-term care. Health services research using nationwide claims data would help sustain the LTCI system through evidence-based policymaking. Recent studies have explored how to prevent deterioration of care need levels among residents of long-term care welfare facilities and how to promote a shift from facility-based to home-based long-term care services. By 2025, as the baby boomer generation is projected to reach the age of 75, the Japanese government is planning to establish a community-based integrated care system. Harmonization between long-term care and medical care, involving the informal sector and nonprofit organizations, would mitigate the increasing cost of both the NHI and LTCI systems. To achieve this, more research is warranted to understand how long-term care, medical care, and informal care can be effectively integrated in the community.
Highlights
Introduction of the LongTermCare Insurance System (2000)1989 Establishment of the Gold Plan (10-year strategy for the promotion of health and welfare for the elderly)◇ Promotion of the urgent preparation of facilities and in-home welfare services1994 Establishment of the New Gold Plan◇ Improvement of in-home long-term care1997 Enactment of the Long-Term Care Insurance Act2000 Enforcement of the Long-Term Care Insurance SystemProblems before introducing the Long-Term Care Insurance SystemWelfare system for the elderlyServices provided: Medical system for the elderly
○Long-term hospitalization to be cared in hospitals (“social hospitalization”) increased: hospitalization fee is less expensive than welfare services for middle/upper income group, as well as basic maintenance of the welfare service was insufficient
Support for independence: The idea of Long-Term Care Insurance System is to support the independence of elderly people, rather than providing personal care
Summary
Sources: For Japan – Ministry of Internal Affairs and Communications, Population Census; National Institute of Population and Social Security Research –. “Population Projections for Japan (January 2012 estimate): Medium-Fertility & Medium-Mortality Assumption” (Figures as of Oct. 1 of each year). By examining changes in Japan’s demographic makeup , it can be seen that the current social structure consists of 2.6 persons supporting each elderly person. In 2060, with the progression of the aging population and decreasing birthrate, it is estimated that 1.2 person will be supporting one senior citizen
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