Abstract
Regional areas, in which land rents are relatively low, clearly possess a comparative advantage in the provision of elderly services. Nevertheless, regional municipalities do not welcome influxes of elderly residents, because such influxes disadvantage regional municipal governments by requiring them to shoulder a considerable financial burden for social security while providing virtually no increase in local tax revenues.
Influxes of elderly residents would be stimulated if the national government paid an amount corresponding to a “model benefit” for each insurance subscriber, based on the average per person benefit for that age cohort throughout the entire country.
The present chapter estimates that the model benefit would be 125,000 yen for each additional resident younger than 65, and 556,000 yen for each additional resident older than 65.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
In the present chapter, local governments include both prefectural and municipal administrations.
- 2.
At present, National Health Insurance benefits are being aggregated at the prefectural level. Because the prefectures will still face a burden even when this process is completed, the factors which work to control inflows of elderly residents will still be in effect. In addition, because this system will basically mean government subsidization of the actual cost of treatment, it will not offer prefectures any motivation to economize on benefit payments.
- 3.
At present, benefit payments are being aggregated at the prefectural level. Nevertheless, this still produces a greater incentive for the reduction of benefit payments than would be the case if the government provided the payments en bloc. However, if the focus were returned to the city, town, and village level, the incentive would become stronger.
- 4.
Because students and homemakers are included in the category of subscribers under the age of 65, they cannot be called “workers.” At the same time, because people aged 60 and over are also included, they cannot be called “young people” in the normally accepted sense. However, because they are young by comparison with elderly people aged 65 and above, this category will be called “young subscribers.”
- 5.
If we were able to use micro data, it would be possible to estimate model benefits for each age group. However, for the present estimation we are making use of macro data only, and therefore divide the population into “the young” and “the elderly.”
- 6.
The same result could be achieved by raising the annual rental fee paid to the government by the holders of rights by 10% increments.
- 7.
For concrete measures to be put in place during the transitional phase, see Hatta (2016b).
References
Hatta, Tatsuo (1996), “Remark,” in Hatta, T. et al. (eds.), Fukushi wa Toushi Dearu (Welfare is an Investment), Nihon Hyoron Sha Press, pp. 172–173.
Hatta, Tatsuo (2015a). ‘Chihososei wo Tou (Ge) –Iju no Shouheki-teppai koso Senketsu (Questioning Regional Revitalization (Part 2): Removing Barriers to Immigration Is the First Priority),’ Nihon Keizai Shimbun, Morning Edition, February 6, 2015 (in Japanese).
Hatta, Tatsuo (2015b). “Kokudo no Kinkoaru-hatten’ Ron wa Nihon no Suitai wo Maneku (‘Balanced National Development’ Threatens Japan with Decline).’ Zenshiten: Jinko-kyugen to Jichitai-shometsu (The Issues in Question: Rapid Population Decline and the Disappearance of Small Municipalities in Japan), Jiji Press, Ltd., February 2015, pp. 64–67 (in Japanese).
Hatta, Tatsuo (2016a). “Kokuho no “Moderu-kyuhugaku” Kokkohutanseido’ niyoru Chihososei (Regional Revitalization via a System for the Contribution of “Model Benefits” by the Government),’ Japanese Journal of Health Economics and Policy, Vol. 27, No. 2, pp. 71–84 (in Japanese).
Hatta, Tatsuo (2016b). ‘Koreika to Chihozaisei (Aging Society and Local Government Finance).’ East Asian Economic Perspectives (Journal of AGI), December 2016, No.27, Vol.2, pp. 1–14 (http://shiten.agi.or.jp/2016/12/1407/) (in Japanese).
Hayashi, Masayoshi (2012). Channels of stabilization in a system of local public health insurance: the case of the National Health Insurance in Japan. CIRJE-F-847.
Hayashi, Masayoshi (2015). ‘Health Care, Long-term Care, and Local Public Finances.’ SPACE NIRA, Unit 01-B.
Iwamoto, Yasushi (1996), “Shian: Iryohokenseido Ichigenka (Designing an Integration of Health Insurance Groups),” Nihon Keizai Kenkyu (JCER Economic Journal), No. 33, November, pp. 119–142 (included in Hatta, T. and Yashiro, N. (eds.) (1998), “Shakaihoken Kaikaku (Social Insurance Reforms),” Series Gendai Keizai Kenkyu Vol. 16 (Contemporary Economic Study Series Vol. 16), Nihon Keizai Shimbun) (in Japanese).
Iwamoto, Yasushi (2015). ‘Designing New Systems through Risk Adjustment.’ SPACE NIRA, Unit 01-A.
Kawabuchi, Koichi (2002). Iryo kaikaku –Itami wo kanjinai seidosekkei wo (Health Care Reform). Tokyo Keizai Shinposha (in Japanese).
Ministry of Health, Labour and Welfare (2015). ‘Documents Prepared by National Health Insurance Division, Health Insurance Bureau, MHLW for “Zenkoku Koreishairyo Shukannka(bu) cho oyobi Kokuminkenko Hoken Shukanka(bu) cho narabini Koki-koreishairyo Koikirengo Jimukyokucho Kaigi (National Meetings for Department/Division Chiefs of Elderly Medical Service, Department/Division Chiefs of National Health Insurance and Secretary-generals of Wide Area Unions for the Late-stage Medical Care System for the Elderly)”’ (in Japanese).
Ministry of Land, Infrastructure, Transport and Tourism (2016). 2014 Land Price Research by Prefectural Governments.
Okabe, Yoji (2014). ‘Kino shitenai byoshokisei no zenpai wo –Kitokukenneki wo hogosuru kyousouseigen seisaku (Abolishing the regulation for the number of hospital beds which failed to function – Competition-restrictive policies protecting vested interests).’ Kinyu Zaisei Business (Financial & Fiscal Businesss), 10392, pp. 12–17, Jiji Press, Ltd (in Japanese).
Suzuki, Wataru (2010). Shakaihosho no ‘Futsugo na Shinjitu’ (‘Inconvenient Truth’ of Social Security). Nikkei Publishing Inc (in Japanese).
Suzuki, Wataru (2015). ‘Local Government Financing of Health Insurance and Regional Revitalization—Facilitating Migration of the Elderly.’ SPACE NIRA, Unit 01 Kick-off paper.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 The Author(s)
About this chapter
Cite this chapter
Hatta, T. (2018). Provision of National Health Insurance “Model Benefits” to Japan’s Prefectures. In: Hatta, T. (eds) Economic Challenges Facing Japan’s Regional Areas. Palgrave Pivot, Singapore. https://doi.org/10.1007/978-981-10-7110-2_13
Download citation
DOI: https://doi.org/10.1007/978-981-10-7110-2_13
Published:
Publisher Name: Palgrave Pivot, Singapore
Print ISBN: 978-981-10-7109-6
Online ISBN: 978-981-10-7110-2
eBook Packages: Economics and FinanceEconomics and Finance (R0)