Advertisement

Letter From Tokyo Public Long-Term Care Insurance in Japan

  • Naoki Ikegami
Part of the Keio University Symposia for Life Science and Medicine book series (KEIO, volume 4)

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.

Keywords

Nursing Home Home Care Respite Care Eligibility Status Frail Elderly People 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Organisation of Economic Co-operation and Development (OECD). The policy context. In: OECD. Caring for Frail Elderly People: Policies in Evolution: Social Policy Studies No. 9. Paris, France: OECD; 1996:13–31.Google Scholar
  2. 2.
    Ikegami N. Best medical practice: the case of Japan. Int J Health Plann Manage. 1989;4:181–195.PubMedCrossRefGoogle Scholar
  3. 3.
    Clark DW, Williams TF, eds. Teaching of Chronic Illness and Aging. Bethesda, Md: Government Printing Office; 1973. DHEW publication (NIH) 875–876.Google Scholar
  4. 4.
    Kerkstra A. Home care in the Netherlands. In: Hütten JBF, Kerkstra A, eds. Home Care in Europe. Aldershot, Hampshire: Ashgate Publishing Ltd; 1996:219–244.Google Scholar
  5. 5.
    Alber J. The debate about long-term care reform in Germany. In: Organisation of Economic Co-operation and Development (OECD). Caring for Frail Elderly People: Policies in Evolution: Social Policy Studies No. 9. Paris, France: OECD; 1996:261–278.Google Scholar
  6. 6.
    Ikegami N, Campbell JC. Medical care in Japan. N Engl J Med. 1995;333:1295–1299.PubMedCrossRefGoogle Scholar
  7. 7.
    Ishikawa A. Population. In: Miura F, ed. Illustrated White Paper for the Elderly, 1996 [in Japanese]. Tokyo, Japan: Zenkoku Shakai-fukushi Kyogikai; 1996:32.Google Scholar
  8. 8.
    Okuyama M. Family. In: Miura F, ed. Illustrated White Paper for the Elderly, 1996 [in Japanese]. Tokyo, Japan: Zenkoku Shakai-fukushi Kyogikai; 1996:48.Google Scholar
  9. 9.
    Tokyo Metropolitan Government Welfare Dept. Survey of the Lives of the Elderly, FY 1990 [in Japanese]. Tokyo, Japan: Tokyo Metropolitan Government Welfare Dept; 1991:115.Google Scholar
  10. 10.
    Prime Minister’s Office. Opinion Survey of People’s Attitude Towards LTC Insurance [in Japanese]. Tokyo, Japan: Prime Minister’s Office; 1995.Google Scholar
  11. 11.
    Campbell JC. How Policies Change: The Japanese Government and the Aging Society. Princeton, NJ: Princeton University Press; 1992:245–247.Google Scholar
  12. 12.
    Japan Ministry of Health and Welfare. Trends in the Nation’s Welfare [in Japanese]. Tokyo, Japan: Kousei Tokei Kyokai; 1996:198–200.Google Scholar
  13. 13.
    Ikegami N, Fries BE, Takagi Y, et al. Applying Rug-III in Japanese long-term care facilities. Gerontologist. 1994;34:628–639.PubMedCrossRefGoogle Scholar
  14. 14.
    Japan Ministry of Health and Welfare. 1993 Patient Survey [in Japanese]. Tokyo, Japan: Kousei Tokei Kyokai; 1995.Google Scholar
  15. 15.
    Japan Ministry of Health and Welfare. 1963 Patient Survey [in Japanese]. Tokyo, Japan: Kousei Tokei Kyokai; 1965.Google Scholar
  16. 16.
    Ohkuma K. Geriatric Hospitals [in Japanese]. Tokyo, Japan: Asahi Shinbunsha; 1988.Google Scholar
  17. 17.
    Japan Ministry of Health and Welfare. 1995 Report on the State of Health Facilities for the Elderly [in Japanese]. Tokyo, Japan: Kousei Tokei Kyokai; 1997.Google Scholar
  18. 18.
    Ikegami N, Morris JN, Fries BE. Low-care cases in long-term care settings: variation among nations. Age Ageing. In press.Google Scholar
  19. 19.
    Interview with Dr Tsuboi, President, Japan Medical Association. Nichi (JMA) News. January 20, 1997:1.Google Scholar
  20. 20.
    Japan Ministry of Health and Welfare. Points for LTC Insurance [in Japanese]. 2nd ed. Tokyo, Japan: Ministry of Health and Welfare; 1996.Google Scholar
  21. 21.
    Kaihara N. Estimation of the New Demand for Physicians, FY 1992: Report of the Health Science Grants Study [in Japanese]. Tokyo, Japan: Ministry of Health & Welfare; 1992.Google Scholar
  22. 22.
    Japan Ministry of Health and Welfare. Points for Determining Eligibility Criteria and Care Plans. Distributed at the 36th meeting of the Health and Social Services Council for the Elderly; March 28, 1996; Tokyo, Japan.Google Scholar
  23. 23.
    Campbell JC. Bureaucracy and democracy in Japan. In: Ishida T, Kraus ES, eds. Democracy in Japan. Pittsburgh, Pa: University of Pittsburgh Press; 1989:113–137.Google Scholar
  24. 24.
    Campbell JC, Ikegami N. The Art of Balancing in Health Policy: Maintaining Japan’s Low Cost, Egalitarian System. New York, NY: Cambridge University Press. In press.Google Scholar
  25. 25.
    Japan Medical Association. Reform of the Health Insurance System for the 21st Century [in Japanese]. Tokyo, Japan: Japan Medical Association; 1997.Google Scholar
  26. 26.
    Ikegami N. Functional assessment and its place in health care. N Engl J Med. 1995; 332:598–599.PubMedCrossRefGoogle Scholar
  27. 27.
    Challis D, Davies B, Traske K. Immediate concerns and long-term care perspectives. In: Challis D, Davies B, Traske K, eds. New Agendas and Challenges in Community Care of the Elderly: Lessons From the UK and Overseas. Aldershot, Hampshire: Ashgate Publishing Ltd; 1994:303–316.Google Scholar
  28. 28.
    Ikegami N, Fries BE, Igarashi C, et al. Long-term care payment: assessment and care planning in home care [in Japanese]. Byoin Kanri. 1996;33:343–352.Google Scholar
  29. 29.
    Morris JN, Fries BE, Steel K, Ikegami N, et al. Comprehensive clinical assessment in community setting: applicability of the MDS-HC. J Am Geriatr Soc. 1997;45:1017–1024.PubMedGoogle Scholar
  30. 30.
    Japan Ministry of Health and Welfare. 1995 White Paper on Health and Welfare [in Japanese]. Tokyo, Japan: Gyousei; 1995:19.Google Scholar
  31. 31.
    Block SD, Clark-Chiarelli N, Peters AS, et al. Academia’s chilly climate for primary care. JAMA. 1996;276:677–682.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1999

Authors and Affiliations

  • Naoki Ikegami

There are no affiliations available

Personalised recommendations