Twelve Years Experiences of the Japanese Long Term Care Insurance

Abstract

In 2000, the Japanese government implemented the Long Term Care Insurance (LTCI) as a new scheme for the frail elderly in order to socialize the ADL care services for the dependent elderly. After 12 years of implementation, LTCI has become an important infrastructure to support the QOL of frail elderly. This situation has caused, naturally, a large increase in users and expenditures. LTCI expenditures have increased from 3,953.5 billion JPY in 2000 to 7,930.8 billion JPY in 2010. The average monthly premium has increased from 2,911 JPY to 4,972 JPY in 2012. This rapid increase of LTCI expenditures are one of the most important political issue for today’s Japanese society. In 2012, the Japanese government has 10 trillion of debt. As the expenditure of social security is the largest among national budget, the reform of social security system becomes an urgent political issue for the Japanese society. In order to maintain the universal coverage of LTCI scheme, policies are needed to reconcile projected demand for (and cost of) LTC, with financial sustainability. A toolkit of policies to strike this delicate balance between fairness and fiscal sustainability is now to be prepared. We have to overhaul our LTCI scheme from the following four viewpoints; reducing the demand for care, cost-sharing on LTC benefits, an appropriate mix of formal and informal service and reconfirmation of principle of LTCI scheme among the citizens.