Health Care, Long-term Care, and Local Public Finances: Intergovernmental Financing of Social Insurance Programs

  • Masayoshi Hayashi


Local governments form an integral part of the Japanese system of health and long-term care for the elderly. In particular, municipalities (cities, towns, and villages) manage National Health Insurance (NHI) programs and Long-term Care Insurance (LTCI) programs for their elderly residents. Furthermore, all municipalities within a given prefecture form an administrative unit which finances the costs of medical benefits for those aged 75 and above. This chapter offers a brief overview of the role of local governments in financing NHI and LTCI benefits. In addition, it discusses some of the policy issues that the NHI and LTCI systems are facing, including compromised horizontal equity, potential failure to pool risks, and adverse incentives for municipalities to ration social services.


Intergovernmental relations Long-term care Public health insurance Long-term Care Insurance National Health Insurance Regional insurance 


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© The Author(s) 2018

Authors and Affiliations

  • Masayoshi Hayashi
    • 1
  1. 1.Faculty & Graduate School of EconomicsUniversity of TokyoTokyoJapan

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