Aging, Pensions and Long-term Care: What, Why, Who, How?; Comment on “Financing Long-term Care: Lessons From Japan” (original) (raw)
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International Journal of Health Policy and Management, 2019
Globally, aging populations are driving the demand for long-term care (LTC) services for a growing number of older people with disabilities or chronic illnesses. A key challenge for policy-makers in all countries is to find a comprehensive solution to financing LTC services to make them widely accessible, affordable, and equitable for all in need. In this commentary, we make a case for LTC policy-makers and reformers across countries to take a long-term vision toward establishing a public, mandatory social insurance model of LTC financing. We first take a hard look at the LTC financing problems and the limitations of existing financing options. We then argue for a public social insurance approach to LTC financing and offer insights into several top-level insurance design features that are key to successful implementation of a public social insurance model, building on the experiences and lessons learned from Japan and other countries that have already "gotten there. " We conclude with additional thoughts on the future of public LTC insurance in a global context, including the prospect of spreading this model to middle-income countries.
2020
This article compares the provision of long-term care (LTC) in Japan and Spain, two countries with similar demographic structures but which address the provision of LTCs in very different ways. Both countries provide universal LTC. However, Japan has developed a generous benefit package of formal services for dependents to alleviate the care burden on the family, but provides no cash benefits. In Spain, on the other hand, cash allowances are the norm rather than the exception in the practical implementation of LTC services. After discussing the necessary delineation of LTC in response to future sociodemographic challenges, we discuss LTC system characteristics and the recent cost containment reforms implemented in Japan and Spain. Finally, we consider the lessons that may be drawn from each country’s experience and the reforms that must be undertaken in order ensure the sustainability of LTC provision in other countries with incipient or more developed LTC systems. In addition, since Japan and Spain are both faced with challenging demographic projections, it is important for each country to learn from the other’s initiatives and reforms.
The Evolution of Long-term Care Programs; Comment on “Financing Long-term Care: Lessons From Japan”
2020
The need for long-term care (LTC) represents a “new social risk,” one that overlaps with and complements systems of care that pre-date such programs, complicating LTC program design. This commentary expands on Ikegami’s discussion of how these structural factors must be accommodated, as well as historical and cultural factors that influence public expectations of such a program. The commentary specifically focuses on the role of cash payments, caregiver benefits, and the sometimes indistinct line between LTC and health systems. The experiences of countries operating LTC program in a wide range of contexts can illuminate common challenges, as well as some potential solutions to these vexing design and operational issues.
Archives of Public Health
The two important elements of universal health coverage—(1) enabling everyone to access the necessary health services and (2) providing financial protection from catastrophic health spending—are vital for not only healthcare but also long-term care in the context of population ageing. In this review, we provide an overview of the public long-term care system in Japan to help other countries that are experiencing (or are expected to experience) problems associated with population ageing. Japan’s approach to long-term care may not be universally generalisable, given the differences in population/geographical sizes, socioeconomic development, population ageing, and cultures across countries. However, the challenges faced by older people may be common. Japan’s long-term care system has several challenges, including financing, labour force shortages, support for people with dementia, an integrated continuum of healthcare and long-term care, and utilising services outside the purview of i...
The Future of Long-term Care in Japan
This paper reviews a decade of implementation of the public long-term care insurance (LTCI) program in Japan, which is now experiencing unprecedented pressure from its rapidly aging population. This overview of the program's features focuses on the incentive mechanisms and diversity, and examines official future projections of LTCI costs and their accompanying assumptions. It also includes the discussion of possible reforms for the LTCI program, with an emphasis on the micro aspects of LTCI, as evidenced by the Japanese Study on Aging and Retirement (JSTAR).
Aged-Care Support in Japan: Perspectives and Challenges
2004
Global aging experts are beginning to express grave concern about the extent of medical and social services that will be demanded in years to come by a growing but increasingly frail older population. It is in this context that long-term care (LTC) benefits become an important public policy issue with extraordinary fiscal implications as the world ages. This paper explores economic aspects of the market for long term care with a special focus on Japan. First, we describe the LTC system in Japan as presently implemented, and we highlight some aspects of the program that are novel and potentially of interest to other countries seeking models for long-term care provision. Next we discuss alternative projections of Japanese LTC utilization and costs. Finally, since Japan appears likely to experience important shortfalls in LTC in the future, we discuss whether such services might be more efficiently organized and financed under alternate forms of provision.
Social Inequality under a New Social Contract: Long-term Care in Japan
Social Policy and Administration, 2003
The s saw the beginning of new developments in the social policy agenda of Japan. A combination of further cuts in social expenditure and increases in financial resources through various means has become inevitable in response to the increasing cost burden of an ageing society, the prolonged recession and changes in the Japanese family. In this context, "kaigo hoken" (longterm care insurance) was introduced in to increase revenue and fill the gap vacated by the family. The scheme introduced a different concept to the public: that long-term care was no longer "expected'' from the family or "allocated" by the state, but has become part of a "social contract" based upon a system of mandatory contributions, uniform entitlements and consumer choice. This paper first explores the role of the new scheme in creating social inequalities among individuals (and families). A panel survey is used to highlight different patterns of care provision and the varying degree of financial pressure among different income groups. Second, based on qualitative research, the paper examines how the new scheme has transformed the relationship between older people and their families who have played a central role in this arena. The scheme has consequently divided "traditional" families and their liberal counterparts, as a result of care work being "commodified". It is apparent that this scheme has not only responded to fill the existing care gap but may also help accelerate the changes that have been taking place for the last two decades.
Lessons From Public Long-Term Care Insurance In Germany And Japan
Health Affairs, 2010
The U.S. Congress is considering the Community Living Assistance Services and Supports (CLASS) Act, a voluntary insurance program that would help pay for long-term services and supports to disabled Americans. In Germany and Japan, social insurance programs are universal, support family caregivers, and allow individuals considerable flexibility in securing the services they require. We explored differences between Germany and Japan in program goals, eligibility process, scope, size, and sustainability for possible applications in the United States. Moreover, when we compared public spending on longterm care, we found that spending in the United States is actually higher than in Germany even now, prior to enactment of the CLASS Act, and is only slightly lower than in Japan. T wenty years ago, policy for care of frail older people in Germany and Japan was much like it is in the United States today. Programs financed mostly from tax revenues provided means-tested access to nursing homes and, in some areas, to a few community-based services such as home help. Today, Germany and Japan have universal, comprehensive long-term care systems based on social insurance. A variation on this model is now under consideration in the U.S. Congress, in the form of the Community Living Assistance Services and Supports (CLASS) Act, a national voluntary insurance program that would help pay for long-term services and supports to some disabled Americans. In this article we argue that an even broader program of universal long-term care insurance is a practical and affordable solution to problems of coverage and fairness, and we describe differences between the German and Japanese programs that illustrate some important policy choices. Public Long-Term Care Spending Compared We start with a look at what Germany, Japan, and the United States spend on long-term care. Cross-national data compilations that allow separation of spending on the elderly are not available, so we compiled basic data on long-term care spending using best available data from 2005, the latest year with complete data for Germany and Japan. 1-6 We adjusted these data to exclude spending for people under age sixty-five in the United States and Germany, by referring to unpublished data or estimating on the basis of the best information available. (In Japan the official data are broken down by age.) 7,8 We did our best to define consistent categories across the three countries, again estimating in a few cases. For example, there are no official data on long-term care provided in hospitals and paid by health insurance in Japan. In some instances, we consulted the officials or experts who had compiled the data we used to ensure that our estimates were reasonable. To maintain comparability among the countries, we excluded most Medicare postacute spending, because it would be regarded as med
2019
Based on the experiences of Japan and Germany, Ikegami argues that middle-income countries should introduce public long-term care insurance (LTCi) at an early stage, before benefits have expanded as a result of ad hoc policy decisions to win popular support. The experience of the Netherlands, however, shows that an early introduction of public LTCi may not prevent, but instead even facilitate later extensions of public coverage. We argue that social norms and cultural values about caring for the elderly might be the main driver of expansions of LTCi coverage. Furthermore, we posit that this expansion may reinforce the social norms supporting it. Hence, politicians and policy-makers should be aware of this possible self-reinforcing effect.