Just as Japan's elderly population continues to grow, their care needs are growing too. Japan initiated mandatory long-term care insurance (LCTI) in 2000 to help older people lead more independent lives and relieve the burden on family caregivers. The fourth paper in The Lancet Japan Series reflects on LCTI and the future of aged care in the country.
Within the next two decades, the number of people aged 65 and over in Japan will hit (and level off at) 40 million. More than half of the nation's elderly (57%) report no financial hardship, much better than the USA (36%) and France (18%). Most elderly Japanese (85%) report no impediment to their daily life, compared with 65% in the USA. Many elderly residents (41%) live in a house with a child present, compared to 15% in Europe.
LCTI is one of the most generous long-term care systems in the world in terms of coverage and benefits (with more spent per head than in Germany and USA). People aged 40-65 years pay a premium of 1% of their income (up to a defined cap), and all people aged 65 years and over with disability are eligible). Adults 40 to 64 years with disability by age-related diseases are also covered. Eligibility is then determined by a 74-point questionnaire based on activities of daily living. Benefits are worth between US$400 and $2900 per month depending on the care needed, with a 10% co-payment from clients.
The first decade of operation of LCTI has proven it to be effective and manageable. An unusual aspect is that it provides services only, not cash allowances. Other distinctive features include consumer choice with expert advice, comprehensive organisation with flexibility in management, and specialisation in older people.The most popular service is adult day care, with 1.9 million users (6.5% of people 65 years and older), benefiting both these frail older people and their carers. Home help, bathing, and nurse visits are other examples of services. The authors say LTCI has increased the use of formal care and reduced financial burdens. But they also note that labour participation by family carers increased only in high-income households, since these were the ones losing the most being carers at home. People with lower earning potential often chose to remain carers since the cost of paying the co-payment can outweigh the benefits of working.
The authors conclude: "Policy makers in both developed and developing nations can benefit from Japan's experience in initiating one of the world's most comprehensive long-term care systems to cope with the world's most rapidly ageing population… The Japanese approach, with formal services designed specifically for older people (with separate programmes to serve younger disabled people), is more effective and efficient, and is the direct solution to the difficulty that governments most worry about: how to deal with the increasing numbers of frail older people."
Professor Nanako Tamiya, Department of Health Services Research, Graduate School of Human Care Sciences, University of Tsukuba, Ibaraki, Japan T) +81 (0) 29 85 8324 E) ntamiya@md.tsukuba.ac.jp
Haruko Noguchi, National Institute of Population and Social Security Research, Tokyo, Japan T) +81 (0)3 3595 2984 E) h.noguchi@ipss.go.jp
Professor John Creighton Campbell, Institute of Gerontology, University of Tokyo, Japan, and University of Michigan, Ann Arbor, MI, USA. T) +1 510-229-6124 jccamp@umich.edu
Journal
The Lancet