Public Long-term Care Insurance in Japan

TLDR

Japan is preparing to introduce a public long‑term care insurance program in 2000 to address an aging society, dissatisfaction with the current system, and limited mechanisms to control costs and design eligibility. The study aims to define a basic LTC package, an organizational mechanism, and an assessment instrument to deliver services efficiently and equitably, and to involve physicians beyond the traditional medical model. The proposed system will finance half of LTC costs through premiums on those over 40 and half via general taxation, with municipalities acting as insurers and a national pooling mechanism to balance demographic differences; benefits will cover institutional, respite, day, home care, visiting nurses, device loans, and eligibility will be classified into six levels based on functional and cognitive assessment.

Abstract

A public long-term care (LTC) insurance program is likely to be introduced to Japan in the year 2000. A consensus on the need for more LTC resources in the rapidly aging society and dissatisfaction with the current system are some of the factors that have contributed to its introduction. Half the costs will be paid by premiums that will be levied on all those older than 40 years, and half will be covered by general taxation. The insurer will be the municipalities with a pooling mechanism at the national level to balance the differences in their demographic structure. The benefits will include institutional care, respite care, day care, home help, visiting nurses, and loan of devices. Eligibility status will be classified into 6 levels that will be determined by assessment of functional and cognitive status. However, there are few mechanisms to limit benefits and contain costs. Problems also exist in the design of the eligibility classification and in the assessment instrument. The proposed LTC insurance system highlights the need for defining what should be included in a "basic package" of LTC as an entitlement for every citizen, for an organizational mechanism and an assessment instrument to deliver services efficiently and equitably, and for physicians to work outside the traditional medical model. To what degree the Japanese public in general, and physicians in particular, is willing to deal with these issues is a challenge for the 21st century.