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National Long-Term Care Insurance Policy in Japan a Decade after Implementation: Some Lessons for Aging Countries

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Abstract

In recent years, several rapidly aging countries have looked towards the introduction of a national long-term care insurance (LTCI) policy to deal with the needs of their graying population. This article presents a comprehensive overview of the LTCI policy in Japan and the reforms made, and discusses the successes and challenges of the policy over the ten-year period since its implementation in April 2000. The objective is to provide some policy guidelines so that other countries can benefit from Japan’s early experience. All Japanese adults aged 65+ are covered by the LTCI program and are eligible for both in-home and institutional-care services after a systematic and thorough care-level certification process. The utilization of services is planned and coordinated by care managers. The program is financed by a mix of general tax revenues from the three levels of government, income-tested premiums, and standardized co-payments. Reforms in later years included the introduction of preventive services and the levy of charges on accommodation and meals at institutional facilities. A key success of the policy is its universal and comprehensive coverage. Notwithstanding this success, increasing costs continue to remain a challenge as Japan’s population ages further and the number of LTCI users increases.

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Notes

  1. A national report indicated that over half (53%) of caregivers to bedridden elderly are aged 60 years and over (Ministry of Health, Labour and Welfare 2002).

  2. Disabilities resulting from non health-related causes such as motor vehicle accidents for this age group are excluded from the LTCI scheme.

  3. More details on home modification provisions under the LTCI policy can be found in Makigami and Pynoos (2002). The evolution of home modification programs in Japan. Ageing International, 27(3), 95–112.

  4. The six levels of care classification were increased to seven levels in a reform in 2006. See next section in this paper for more details.

  5. The computer program, developed by the national government, was an adaption of the United States’ system of Resources Utilization Groups (RUGS) (Tsutsui and Muramatsu 2005).

  6. As of FY 2006, the level of care classification was changed to increase from 6 to 7. The lightest level, “support required” is split into two levels, with preventive services available for these two levels (Mitchell et al. 2008). See next section of this paper.

  7. Applicants and their families can also choose their own care manager or decide not to use one and coordinate their own providers and services instead, but the vast majority opt to use a care manager.

  8. The conversion from Japanese yen to US dollars is based on an approximate average exchange rate of 100 yen to US$1.

  9. Japanese adults aged 40–64 are included for LTCI coverage since they contribute to premium payments. However, in order to control costs, their benefits are limited to age-related illnesses and diseases only (Campbell and Ikegami 2000).

  10. While these are real concerns regarding the abuse of the LTCI scheme by care managers, audits conducted by the insurers (the municipal governments) have shown that the concerns have thus far been unfounded (Kikuchi et al. 2006).

  11. In formulating the LTCI policy in Japan, policymakers have debated on whether to offer cash benefits too, as in the German system. However, because of concerns over how the cash benefits will be used and whether they will be subsumed under household expenditures with no decrease in care-giving strain for female caregivers, the Japanese government decided that only care services would be provided.

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Acknowledgements

This research was supported by a grant, Academic Frontier Project for Private Universities: a matching fund subsidy from the Ministry of Education, Culture, Sports, Science and Technology (2006-2010).

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Authors and Affiliations

  1. Advanced Research Institute for the Sciences and Humanities, Nihon University, 12-5 Goban-cho, Chiyoda-ku, Tokyo, 102-8251, Japan

    Vanessa Yong & Yasuhiko Saito

  2. Population Research Institute, Nihon University, 1-3-2 Misaki-cho, Chiyoda-ku, Tokyo, 101-8360, Japan

    Vanessa Yong & Yasuhiko Saito

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  1. Vanessa Yong
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  2. Yasuhiko Saito
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Correspondence to Vanessa Yong.

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Yong, V., Saito, Y. National Long-Term Care Insurance Policy in Japan a Decade after Implementation: Some Lessons for Aging Countries. Ageing Int 37, 271–284 (2012). https://doi.org/10.1007/s12126-011-9109-0

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