In this slideshow, Masahiko Hayashi, Deputy Assistant to the Minister for International Affairs, Ministry of Health, Labour and Welfare, Japan, provides an overview of long-term care insurance in Japan and considers its’ future.

1. Shifting Values : How should we care for older people in society
Long-term care insurance
in Japan
- Social background, evaluation and future November 2013
Masahiko HAYASHI
Deputy Assistant Minister for International Affairs
Ministry of Health, Labor and Welfare Japan

2. Agenda for this presentation
1. Why do they accept establishment of long-term
care insurance system in Japan?
2. Evaluation of the long-term care insurance system
and its challenges
3. Future of long-term care
2

3. 1. Why do they accept establishment
of long-term care insurance system
in japan?

4. Social background for establishment of
long-term care insurance system
 Rapidly ageing society
(Demographic structure change)
・ very high life expectancy
・ declining (and low) birthrate
 The nuclearization of the family
 Increasing participation of women
 Very heavy burden a family care
person is forced
no family
care person
 Some problems with former long-term care system
Social consensus about establishment
of long-term care insurance existed

5. Rapid increase in number of the elderly aged 75 and older
(%)
Actual values
(Population Census )
Population (10,000 persons)
14,000
2012 estimation
(Population Projections for Japan)
Population peak (2004)
127,790 thousand people
12,000
30
12,806
Percentage of the population aged 75 and older
12,067
1,419
Population aged 75 and older
Peak of the number of elderly
38,780 thousand people (2042)
26.9%
2,179
1,529
Population aged 65 - 74
10,000
1,479
18.1%
8,674 20
2,336
Percentage of the population aged 65 - 74
8,000
Population aged 15 - 64
8,174
13.0%
15
12.3%
11.9%
6,000
25
1,128
7,085
10
11.1%
4,000
4,418
5
2,000
Population aged 14 and younger
0
1950
Source:
1955
1960
1965
197 0
197 5
1980
1985
1990
1995
1,684
200 0
200 5
2010
1,324
2015
2020
2025
203 0
203 5
2040
2045
2050
2055
Statistics Bureau of the Ministry of Internal Affairs and Communications “Population Census,” National Institute of Population and Social
Security Research “Population Projections for Japan assuming medium-fertility/medium-mortality”(estimated in Jan. 2012)”, Values of
2010 are from Statistics Bureau of the Ministry of Internal Affairs and Communications “Base Population according to 2010 Population
Census” (Base Population is the population that was corrected by dividing the population of unknown citizenship and age proportionally)
791 0
206 0
5

6. Percentage of population over 80 in OECD
countries
OECD
EU27
Japan
Korea
USA
World
Brazil
China
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
Source：OECD ”Help Wanted? ”

7. Shocking outcomes of public opinion poll !
Difficulties in “house care”




too heavy workload (meal, bath, elimination) : 57.5%
going out is impossible : 36.2%
great psychological burden and stress : 32.0%
lack of sleep : 25.2%
source : “Survey on Trend of Health and Welfare”
Ministry of Health and Welfare (1990)
Feel a hatred against a person who requires nursing care?



daughter in law (wives who nurse her husband's parents) : 46.2%
daughter (women who nurse her parents) : 30.0%
wife (women who nurse her husband) : 33.6%
source : “Survey on the actual conditions of house care person“
Japanese Trade Union Confederation (1994)

8. Problems with the system for long-term care of the elderly before the
adoption of the long-term care insurance system
Welfare for the elderly
Covered services
• Intensive care homes for the elderly, etc.
• Home help services, day services, etc.
(Problems)
 Because municipalities decided the types of
services and their providers, the users could not
choose the services.
 Because income verification was required,
people felt reluctant to use the services.
 Because municipalities generally provided
services directly or via commission, there was no
competition and services tended to be uniform.
 Because copayments were based on the income
of the individual and persons with a duty of
support (ability to pay), the burden on people with
medium-level and high incomes was heavy
Healthcare for the elderly
Covered services
• Health facilities for the elderly, convalescent wards
in hospitals, general hospitals, etc.
• Visiting nurses, day care, etc.
(Problems)
Because medical care was cheaper than the welfare
services for medium- and high-income people and
because the welfare services infrastructure was
insufficient, extended hospital admissions for longterm care became a problem.
→ Compared with intensive care homes for the
elderly, the costs were higher and healthcare
expenditures increased
→Systems for the extended recuperation of persons
needing long-term care were inadequate in terms of
staff and the living environment in hospitals was
intended for patient treatment (living spaces were
small, dining rooms and bathing facilities were
lacking, etc.)
There were limits on the ability of the systems for
elderly welfare/healthcare to respond before the
8
adoption of the long-term care insurance system

9. Differences in the welfare system for the elderly from the user perspective
before and after the introduction of the long-term care insurance system
Before introduction
After introduction
Users themselves choose the types of
services and the vendors
(1) Apply at a government office;
services determined by the
municipality
(2) Apply for healthcare and welfare
services separately
A long-term care services care plan is
created, and comprehensive use is
made of medical and welfare services
(3) Services provided mainly by
municipalities and public institutions
(social welfare councils, etc.)
Services are provided by diverse
vendors, including private-sector firms,
agricultural and other cooperatives,
non-profits, etc.
(4) Expensive and hard to use for people
with medium or high incomes
Regardless of income, users pay 10%
Example: In the case of the head of a household
with an income of 8 million yen and an elderly
parent with a monthly pension of 200,000 yen
 Intensive care home for the elderly:
50,000 yen/month
 Home helper: 400 yen/30–60 minutes
Example: In the case of the head of a household
with an income of 8 million yen and an elderly
parent with a monthly pension of 200,000 yen
 Intensive care home for the elderly:
190,000 yen/month
 Home helper: 950 yen/hour
9

10. 2. Evaluation of the long-term care
insurance system and its challenges

11. Evaluation of long-term care insurance system
 Approx. 60% of persons are appreciating long-term care insurance system (Greatly appreciate:
14%, somewhat appreciate: 47%)
 Persons who are not appreciating account for approx. 20% (not appreciate so much: 19%, not
appreciate at all: 4%)
Evaluation of long-term care insurance system
5. Cannot say
which
10%
No response
6%
1. Greatly
appreciate
14%
4. Not
appreciate at all
4%
3. Not
appreciate so
much
19%
2. Somewhat
appreciate
47%
21

12. Evaluation of long-term care insurance system
[Family burden]
 Approx. 50% of persons feel family members’ burden has become lighter.
 On the other hand, approx. 10% of persons do not feel family members’ burden has become lighter.
[Quality of services]
 Approx. 30% of persons feel quality of services has got better.
 On the other hand, approx. 10% of persons do not feel quality of services has got better.
[Selection of services and service providers]
 Approx. 50% of persons feel it has got easier to select services and service providers.
 On the other hand, approx. 10% do not feel it has got easier.
Family burden becomes
lighter
Quality of services gets
better
No
respon
se
5%
無回答
5%
3. No
13%
3. No
14%
Selection of services
and service providers
get easier
3. No
14%
無回答
5%
1. Yes
34%
1. Yes
46%
2. Yes
and no
31%
1. Yes
51%
2. Yes
and no
47%
2. Yes
and no
35%
22

13. Desire for long-term care (by their own)
[If you need long-term care]
The largest number of persons (46%) want to “receive long-term care at home if there are services that enable
them to live at home independently of their family members.” The second largest (24%) is to “live at home receiving
combination of long-term care by my family” The third largest (12%) is to receive “move into fee charging home for
the aged or house for the elderly with care to receive long-term care.”
How do you want to receive long-term care
if you come to need it?
1. Live at home
6. Stay in the hospital to
receive long-term care
2%
5. Stay in special
nursing home or other
facility for the elderly to
receive long-term care
7%
4. Move into fee
charging home for the
aged or house for the
elderly with care to
receive long-term care.
12%
7. Others
3%
8. No response
2%
receiving cares by
mainly my family
4%
2. Live at home
receiving combination of
external long-term care
services and care by my
family
24%
3. Receive long-term
care at home if there are
services that enable me
to live at home
independently of my
family members
46%
Source: “Opinion collection from the citizens concerning long-term care insurance system (result outline)” by Health and
Welfare Bureau for the Elderly of MHLW
13

14. Desire for long-term care (by families)
[If your parents need long-term care]
 The largest number of persons (49%) want their parents to “receive combination of long-term care services
by external providers and cares by themselves at home.” The second largest (27%) want their parents to
“receive long-term care at home if there are services that enable them to live at home independently of
themselves.” The responses of the largest and second largest are inverted compared to the responses in the
preceding section.
 In either case, larger number of persons want to live at home. Those who want to be institutionalized or
hospitalized account for only less than 10%.
How do you want your parents to receive long-term care
if they come to need it?
6. Stay in the hospital to
receive long-term care
2%
5. Stay in special
nursing home or other
facility for the elderly to
receive long-term care
6%
4. Move into fee
charging home for the
aged or house for the
elderly with care to
receive long-term care.
3. Receive long-term
5%
care at home if there
are services that enable
me to live at home
independently of my
family members
27%
7. Others
3%
8. No response
4%
1. Live at home
receiving cares by
mainly my family
4%
2. Live at home
receiving combination
of external long-term
care services and care
by my family
49%
Source: “Opinion collection from the citizens concerning long-term care insurance system (result outline)” by Health and
14
Welfare Bureau for the Elderly of MHLW

15. 3. Future of long-term care
15

16. Key points for future long-term care
• We will have to manage population aging in big cities,
increasing solo or couple-only family and increasing
dementia.
• The key word is “comprehensive community care”.
• Long term care costs will keep increasing more than
any other area of social security.
• Consequently, the insurance contributions will also
increase.
• We have to make efforts to keep the system
acceptable for people including people who do not
use services (because insurance contributions will
become higher).
16

17. Long-term care in the future (Integrated Community Care System)
 Realization of an integrated community care system which provides housing, healthcare, long-term care, prevention, and livelihood
support services in a unified manner enables the elderly to live in their community and familiar environment throughout their life
even if they come to need advanced level care.
[Measures based on five perspectives]
Following measures based on five perspectives should be implemented comprehensively and consecutively to realize Integrated Community
Care.
1. Cooperation with Healthcare Services
2. Improvement and Reinforcement of LTC Services
3. Promotion of Prevention Programmes
4. Ensuring various life support services such as watching over, meals-on-wheels and shopping, and Advocacy
5. Sufficient supply of Elderly Housings (Collaboration with MLIT)
Healthcare
Integrated community care system in 2025
Long-term care
Commuting to medical
facilities/care facilities
Integrated
community care
support center/
care manager
Housing
Living support/
long-term care prevention
Old people’s club, residents’ association, long-term care
prevention, living support, etc.
* Integrated community care
system regards its unit as juniorhigh school district of the
population of approximately 10
thousand residents

18. Prospect of long-term care service costs
Current cost of approx. 9 trillion yen will be approx. 20 trillion yen in 2025
18 trillion
yen
8.3 trillion
yen
21 trillion
yen
8.9 trillion
yen
2012
2025
2025
(Current scenario)
2011
(Reformed scenario)
*Medical expenditure will be from 40 trillion yen (2012) to 61 – 62 trillion yen (2025)
Source: Prepared from “Review of future estimation of social security-related expenditure” (March, 2012) 18

19. Comprehensive Reform of Social Security and Tax
 Consumption tax (national/regional) will rise in stages to 8% in April, 2014, 10% in October, 2015.
 Use of consumption tax revenue will expand from three types for the elderly (basic pension, medical care for the
elderly, long-term care) to four types of social security (pension, medical care, long-term care, childrearing).
 Clarification of use of consumption tax revenue (Using consumption tax revenue as social security fund resource)
 All consumption tax revenue is used for the sake of the citizens, not for expansion of public sector
Approx
1%
Improvement of social security
Approx. +2.7 trillion yen
Stabilization of social security:
maintaining current social security
system
Approx. +10.8 trillion yen
Approx
4%
 Government share of contribution to
pension is ½ (Including fund gained by
government bonds for pension)
 Lowering the burden passed onto the
next generation
• Existing social security fund that cannot
secure stable financial resource and
that is increasing due to aging
(natural increase)
Approx.
2.9 trillion yen
Approx.
7.0 trillion yen
 Increase in social security expenditure followed by rise of
consumption tax
Approx.
• Increase in pension, medical cost, etc.
followed by price boost
0.8 trillion yen
 Measures for children/childrearing
Approx.
- Solving the issue of children
0.7 trillion yen
waiting for admission to day-carecenter (quantitative improvement in day-care services,
afterschool children’s club)
 Improvement in medical/longterm care
Up to approx.
1.6 trillion yen
- Intensive use of medical resources
in acute phase (strengthening of hospitalization medical
care), improvement of home medical care/long-term care
(from hospital/facilities to community/home), etc.
 Improvement of pension
system
Up to approx.
0.6 trillion yen
- Additional pension to persons with
low income, shortening of
certification term
• Strengthening countermeasures
against poverty/difference
(measures against persons with
low income, etc.)
Among above,
approximately up to 1.4
trillion (already
mentioned above)
• Lowering premium of persons
with low income, comprehensive payment/benefit system, etc.
19

20. Average insurance contributions
9000
8200
Estimation
8000
6900
7000
5700
6000
4972
5000
4000
2911
3000
2000
1000
0
20

21. Thank you!